Provider Demographics
NPI:1700198017
Name:DEVINE, BRIDGET TARA (CNMT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:TARA
Last Name:DEVINE
Suffix:
Gender:F
Credentials:CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 A ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2807
Mailing Address - Country:US
Mailing Address - Phone:781-444-3609
Mailing Address - Fax:
Practice Address - Street 1:150 A ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2807
Practice Address - Country:US
Practice Address - Phone:781-444-3609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4581225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist