Provider Demographics
NPI:1467743757
Name:TUNG, RICHARD (CMT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:TUNG
Suffix:
Gender:M
Credentials:CMT
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 735
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01464-0735
Mailing Address - Country:US
Mailing Address - Phone:617-462-5459
Mailing Address - Fax:
Practice Address - Street 1:9 CREST RD
Practice Address - Street 2:SUITE 13
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-4678
Practice Address - Country:US
Practice Address - Phone:617-462-5459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1318225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist