Provider Demographics
NPI:1770380107
Name:MOONTIDE MASSAGE & WELLNESS LLC
Entity type:Organization
Organization Name:MOONTIDE MASSAGE & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORCROSS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LMT
Authorized Official - Phone:774-836-0985
Mailing Address - Street 1:1550 FALMOUTH RD STE 4C
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-2938
Mailing Address - Country:US
Mailing Address - Phone:508-776-1305
Mailing Address - Fax:508-365-6449
Practice Address - Street 1:1550 FALMOUTH RD STE 4C
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-2938
Practice Address - Country:US
Practice Address - Phone:508-776-1305
Practice Address - Fax:508-365-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty