Provider Demographics
NPI:1144798042
Name:THERAPEUTIC MASSAGE OF SHELBURNE FALLS, LLC
Entity Type:Organization
Organization Name:THERAPEUTIC MASSAGE OF SHELBURNE FALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT, MMP
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DOMPKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-559-8324
Mailing Address - Street 1:1 ASHFIELD ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:01370-1415
Mailing Address - Country:US
Mailing Address - Phone:413-559-8324
Mailing Address - Fax:413-625-2270
Practice Address - Street 1:1 ASHFIELD ST STE 4
Practice Address - Street 2:
Practice Address - City:SHELBURNE FALLS
Practice Address - State:MA
Practice Address - Zip Code:01370-1415
Practice Address - Country:US
Practice Address - Phone:413-559-8324
Practice Address - Fax:413-625-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty