Provider Demographics
NPI:1275907966
Name:STOUGHTON MASSAGE THERAPY, INC
Entity Type:Organization
Organization Name:STOUGHTON MASSAGE THERAPY, INC
Other - Org Name:STOUGHTON MASSAGE THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIELAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:781-626-2643
Mailing Address - Street 1:630 PARK ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3659
Mailing Address - Country:US
Mailing Address - Phone:781-626-2643
Mailing Address - Fax:781-341-1346
Practice Address - Street 1:85 PARK ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2915
Practice Address - Country:US
Practice Address - Phone:781-626-2643
Practice Address - Fax:781-341-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2130-MT-MM261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center