Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 11673 | MA |
NPI | 1013373927 |
---|---|
Provider Name | Ms. Gina M Tacconi-Moore |
First Address | Lowell, MA 01852-5149 |
Second Address | Lowell, MA 01852-5149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2016 |
Last Update Date | 07/01/2016 |