NPIMap

Organization Active NPI

360 Neuromuscular Therapy, LLC

  • Massage Therapist
  • Waltham, MA
National Provider Identifier
1700198306
Registry record updated Feb 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
167 Issued in MA
Legal business name
360 NEUROMUSCULAR THERAPY, LLC
Practice address
1077 Lexington St Ste 202
Waltham, MA 02452-7233
Phone
(781) 444-3609
Fax
(781) 209-7301
NPI assigned
Jul 12, 2010
Last updated
Feb 22, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Lisa Marie Erickson Gorman, CNMT, CMTPTNPI 1043658982
Title
Co-Owner
Phone
(781) 444-3609

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 167 MA Primary

Addresses

Primary practice location

1077 Lexington St Ste 202
Waltham, MA 02452-7233

Mailing address

1077 Lexington St Ste 202
Waltham, MA 02452-7233
Phone (781) 444-3609

National Provider Directory

National Provider Directory

Locations

1077 Lexington St
Ste 202
Waltham, MA 02452
Phone (781) 444-3609

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550793600000",
    "number": "1700198306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1077 LEXINGTON ST STE 202",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024527233",
            "telephone_number": "781-444-3609",
            "fax_number": "781-209-7301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1077 LEXINGTON ST STE 202",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024527233",
            "telephone_number": "781-444-3609",
            "fax_number": "781-209-7301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "360 NEUROMUSCULAR THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-12",
        "last_updated": "2019-02-22",
        "status": "A",
        "authorized_official_last_name": "ERICKSON GORMAN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "781-444-3609",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CNMT, CMTPT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MA",
            "license": "167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.