Provider Demographics
NPI:1639202153
Name:FACCIOLO, BARBARA ANN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:FACCIOLO
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FARAH DR
Mailing Address - Street 2:SHAH VALLEY
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-2217
Mailing Address - Country:US
Mailing Address - Phone:410-620-1413
Mailing Address - Fax:
Practice Address - Street 1:50 FARAH DR
Practice Address - Street 2:SHAH VALLEY
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-2217
Practice Address - Country:US
Practice Address - Phone:410-620-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM02332174400000X
DEMT-0001630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist