Provider Demographics
NPI:1558629311
Name:LO, WAIMAN (LMT)
Entity Type:Individual
Prefix:MISS
First Name:WAIMAN
Middle Name:
Last Name:LO
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 1:1458 HANCOCK ST STE 220
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5214
Mailing Address - Country:US
Mailing Address - Phone:617-328-0888
Mailing Address - Fax:630-584-1157
Practice Address - Street 1:1458 HANCOCK ST STE 220
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5214
Practice Address - Country:US
Practice Address - Phone:617-328-0888
Practice Address - Fax:630-584-1157
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5932225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist