Provider Demographics
NPI:1164733952
Name:ETM MASSAGE OF BURLINGTON, INC
Entity Type:Organization
Organization Name:ETM MASSAGE OF BURLINGTON, INC
Other - Org Name:ELEMENTS THERAPEUTIC MASSAGE BURLINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-270-4433
Mailing Address - Street 1:101 CAMBRIDGE ST STE 260
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3767
Mailing Address - Country:US
Mailing Address - Phone:781-270-4433
Mailing Address - Fax:
Practice Address - Street 1:101 CAMBRIDGE ST STE 260
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3767
Practice Address - Country:US
Practice Address - Phone:781-270-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty