Provider Demographics
NPI:1346615788
Name:MASSE, REBECCA (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MASSE
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:PO BOX 756
Mailing Address - Street 2:
Mailing Address - City:SABATTUS
Mailing Address - State:ME
Mailing Address - Zip Code:04280-0756
Mailing Address - Country:US
Mailing Address - Phone:207-713-6774
Mailing Address - Fax:
Practice Address - Street 1:675 MAIN ST
Practice Address - Street 2:18
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5802
Practice Address - Country:US
Practice Address - Phone:207-713-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2232225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist