Provider Demographics
NPI:1790251726
Name:BASS, DANIEL JONATHAN (LMT, MMP, NMRT, CR)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JONATHAN
Last Name:BASS
Suffix:
Gender:M
Credentials:LMT, MMP, NMRT, CR
Other - Prefix:MR
Other - First Name:DANO
Other - Middle Name:
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT, MMP, NMRT, CR
Mailing Address - Street 1:275 N END BLVD APT C12
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01952-2100
Mailing Address - Country:US
Mailing Address - Phone:251-213-0615
Mailing Address - Fax:
Practice Address - Street 1:275 N END BLVD APT C12
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MA
Practice Address - Zip Code:01952-2100
Practice Address - Country:US
Practice Address - Phone:251-213-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15462225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist