Provider Demographics
NPI:1760268718
Name:SALIS, STACIE E (LMT)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:E
Last Name:SALIS
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 1:65 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-1437
Mailing Address - Country:US
Mailing Address - Phone:774-286-0971
Mailing Address - Fax:
Practice Address - Street 1:63 FOUNTAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6280
Practice Address - Country:US
Practice Address - Phone:413-277-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17329225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist