Provider Demographics
NPI:1932818986
Name:GLASTONBURY MASSAGE CENTER LLC
Entity Type:Organization
Organization Name:GLASTONBURY MASSAGE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-410-4490
Mailing Address - Street 1:730 HEBRON AVE
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-5016
Mailing Address - Country:US
Mailing Address - Phone:860-410-4490
Mailing Address - Fax:860-410-4492
Practice Address - Street 1:730 HEBRON AVE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-5016
Practice Address - Country:US
Practice Address - Phone:860-410-4490
Practice Address - Fax:860-410-4492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAMATO CHIROPRACTIC CENTER OF GLASTONBURY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty