MEDICARE: MOONTIDE MASSAGE & WELLNESS 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	175F00000X	Naturopath
2	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1770380107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOONTIDE MASSAGE & WELLNESS LLC

Provider Business Mailing Address
First Line	:	1550 FALMOUTH RD STE 4C
Second Line	:
City	:	CENTERVILLE
State	:	MA
Zip	:	02632-2938
Country	:	US
Telephone Number	:	508-776-1305
Fax Number	:	508-365-6449

Provider Business Practice Location Address
First Line	:	1550 FALMOUTH RD STE 4C
Second Line	:
City	:	CENTERVILLE
State	:	MA
Zip	:	02632-2938
Country	:	US
Telephone Number	:	508-776-1305
Fax Number	:	508-365-6449

Authorized Official
Title or Position	:	OWNER
Name	:	NORMA NORCROSS
Credential	:	RN, LMT
Telephone Number	:	774-836-0985

Provider Enumeration Date	:	02/25/2025
Last Update Date	:	02/25/2025

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Directions to “MOONTIDE MASSAGE & WELLNESS LLC ” Practice Location

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