Provider Demographics
NPI:1609411495
Name:MENDED ROOTS ACUPUNCTURE AND WELLNESS
Entity Type:Organization
Organization Name:MENDED ROOTS ACUPUNCTURE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:MUFFOLETTO
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC
Authorized Official - Phone:978-813-1120
Mailing Address - Street 1:2 SHAKER RD STE B007
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01464-2585
Mailing Address - Country:US
Mailing Address - Phone:978-813-1120
Mailing Address - Fax:978-813-1126
Practice Address - Street 1:2 SHAKER RD STE B007
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:MA
Practice Address - Zip Code:01464-2585
Practice Address - Country:US
Practice Address - Phone:978-813-1120
Practice Address - Fax:978-813-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty