Provider Demographics
NPI:1518293521
Name:SCHIFF, THEODORE MILES (LMT)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:MILES
Last Name:SCHIFF
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3132
Mailing Address - Country:US
Mailing Address - Phone:413-687-7878
Mailing Address - Fax:775-667-5358
Practice Address - Street 1:39 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3132
Practice Address - Country:US
Practice Address - Phone:413-687-7878
Practice Address - Fax:775-667-5358
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1797225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1797OtherMASSACHUSETTS BOARD OF MASSAGE REGISTRATION