Provider Demographics
NPI:1861897464
Name:MASSAGE MATRIX RI
Entity type:Organization
Organization Name:MASSAGE MATRIX RI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLMT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAPPUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:CLMT
Authorized Official - Phone:401-651-7375
Mailing Address - Street 1:200 LAPHAM FARM RD
Mailing Address - Street 2:
Mailing Address - City:PASCOAG
Mailing Address - State:RI
Mailing Address - Zip Code:02859-4001
Mailing Address - Country:US
Mailing Address - Phone:401-651-7375
Mailing Address - Fax:
Practice Address - Street 1:180 DANIELSON PIKE
Practice Address - Street 2:
Practice Address - City:N SCITUATE
Practice Address - State:RI
Practice Address - Zip Code:02857
Practice Address - Country:US
Practice Address - Phone:401-651-7375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT01946174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty