Provider Demographics
NPI:1346524261
Name:HAINES, ALLISSA (LMT)
Entity Type:Individual
Prefix:
First Name:ALLISSA
Middle Name:
Last Name:HAINES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 E BACON ST # 3
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2107
Mailing Address - Country:US
Mailing Address - Phone:508-208-9484
Mailing Address - Fax:
Practice Address - Street 1:172 E BACON ST # 3
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2107
Practice Address - Country:US
Practice Address - Phone:508-208-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1387225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist