Provider Demographics
NPI:1639760879
Name:A TIME AWAY
Entity Type:Organization
Organization Name:A TIME AWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:K
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-689-6438
Mailing Address - Street 1:244 S MERRIMACK RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049
Mailing Address - Country:US
Mailing Address - Phone:603-689-6438
Mailing Address - Fax:
Practice Address - Street 1:154 BROAD ST STE 1532
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-3205
Practice Address - Country:US
Practice Address - Phone:603-263-4725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-31
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty