Provider Demographics
NPI:1396970919
Name:VENEZIANO, TINA MARIE (LMT)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:VENEZIANO
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 1:171 BIGELOW ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1742
Mailing Address - Country:US
Mailing Address - Phone:617-254-3203
Mailing Address - Fax:
Practice Address - Street 1:705 CAMBRIDGE ST
Practice Address - Street 2:#1
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2803
Practice Address - Country:US
Practice Address - Phone:617-783-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist