Provider Demographics
NPI:1013373927
Name:TACCONI-MOORE, GINA M (LMT)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:M
Last Name:TACCONI-MOORE
Suffix:
Gender:F
Credentials:LMT
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Mailing Address - Street 1:1 FOUNDRY INDUSTRIAL PARK
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-5149
Mailing Address - Country:US
Mailing Address - Phone:978-595-8982
Mailing Address - Fax:
Practice Address - Street 1:1 FOUNDRY INDUSTRIAL PARK
Practice Address - Street 2:BUILDING 2
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-5149
Practice Address - Country:US
Practice Address - Phone:978-595-8982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11673225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist