MEDICARE: A BALANCED BODY MASSAGE THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1063092740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BALANCED BODY MASSAGE THERAPY LLC

Provider Business Mailing Address
First Line	:	10 MARINE ST STE 7
Second Line	:
City	:	THOMASTON
State	:	CT
Zip	:	06787-1470
Country	:	US
Telephone Number	:	860-384-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 MARINE ST STE 7
Second Line	:
City	:	THOMASTON
State	:	CT
Zip	:	06787-1470
Country	:	US
Telephone Number	:	860-384-9000
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LMT
Name	:	ELIZABETH BRANCH
Credential	:
Telephone Number	:	860-201-3532

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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