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General NPI Number Information
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NPI Number | 1932090339
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Entity Type | Organization
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Legal Business Name | LUMINANCE MYOFASCIAL RELEASE LLC
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 26 BRIGHTON ST STE 300
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City | BELMONT
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State | MA
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Zip | 02478-4043
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Country | US
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Telephone | 857-707-7819
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Fax |
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Provider Business Mailing Address
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Address Line | 26 BRIGHTON ST STE 300
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City | BELMONT
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State | MA
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Zip | 02478-4043
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Country | US
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Telephone | 857-707-7819
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST (LMT)
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Name | STEFANIE KRAX
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Credential |
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Telephone | 857-707-7819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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