Provider Demographics
NPI:1386217511
Name:CANTOS, LOURDES M (LMT)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:M
Last Name:CANTOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:HARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT, LE, MMP
Mailing Address - Street 1:35 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-5037
Mailing Address - Country:US
Mailing Address - Phone:508-433-6244
Mailing Address - Fax:508-433-6244
Practice Address - Street 1:35 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-5037
Practice Address - Country:US
Practice Address - Phone:508-433-6244
Practice Address - Fax:508-433-6244
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7318225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA871324731Medicaid