MEDICARE: CHRISTINA DEGIROLAMO L.A.T, A.T.C, L.M.T

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	2255A2300X	Athletic Trainer	2744	MA
2	225700000X	Massage Therapist	14334	MA

General Provider Information

NPI Number	:	1538608344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA DEGIROLAMO L.A.T, A.T.C, L.M.T

Provider Business Mailing Address
First Line	:	1166 WEST ST
Second Line	:
City	:	MANSFIELD
State	:	MA
Zip	:	02048-1038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 HIGHLAND CIR
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3099
Country	:	US
Telephone Number	:	781-444-3609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2017
Last Update Date	:	02/14/2017

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