1861897464 NPI number — MASSAGE MATRIX RI

Table of content: (NPI 1861897464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861897464 NPI number — MASSAGE MATRIX RI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MASSAGE MATRIX RI
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861897464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 LAPHAM FARM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASCOAG
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02859-4001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-651-7375
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 DANIELSON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N SCITUATE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-651-7375
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CAPPUCCIO
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER/CLMT
Authorized Official Telephone Number:
401-651-7375

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MT01946 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)