Provider Demographics
NPI:1902153380
Name:BOSTON PAIN RELIEF MASSAGE THERAPY
Entity Type:Organization
Organization Name:BOSTON PAIN RELIEF MASSAGE THERAPY
Other - Org Name:BOSTON PAIN RELIEF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCY LU
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:508-330-6448
Mailing Address - Street 1:23 KINGS VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1547
Mailing Address - Country:US
Mailing Address - Phone:508-330-6448
Mailing Address - Fax:
Practice Address - Street 1:76 SUMMER ST STE 220
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1273
Practice Address - Country:US
Practice Address - Phone:508-330-6448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMT9145302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization