Provider Demographics
NPI:1467775262
Name:PIONEER VALLEY WELLNESS, INC.
Entity Type:Organization
Organization Name:PIONEER VALLEY WELLNESS, INC.
Other - Org Name:ELEMENTS THERAPEUTIC MASSAGE EAST LONGMEADOW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-525-4456
Mailing Address - Street 1:80 CENTER SQ
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2449
Mailing Address - Country:US
Mailing Address - Phone:413-525-4456
Mailing Address - Fax:413-647-1134
Practice Address - Street 1:80 CENTER SQ
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2449
Practice Address - Country:US
Practice Address - Phone:413-525-4456
Practice Address - Fax:413-647-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty