Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 576 | MA |
NPI | 1013479591 |
---|---|
Provider Name | Anatoliy L Zayenchenko |
First Address | Framingham, MA 01702-6359 |
Second Address | Sharon, MA 02067-3005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2019 |
Last Update Date | 03/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
576 | LICENSE MASSAGE THERAPIST (01) | MA |