Mary Jo Bouman
Individual provider Active NPI Massage Therapist · Dover, MA
NPI 1952791972 · NPPES record last updated Jan 28, 2015
Key facts
- NPI
- 1952791972
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 3396 (MA)
- Practice address
- 310 Dedham St
Dover, MA 02030-2230 - Phone
- (617) 512-3246
- NPI assigned
- Jan 28, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3396 | MA | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 3396 | MA | Yes |
Addresses
Primary practice location
310 Dedham St
Dover, MA 02030-2230
Mailing address
310 Dedham St
Dover, MA 02030-2230
Phone (617) 512-3246
Other providers in Dover, MA
- Marjorie Adams
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- Beacon Pathology LLC
- Gregory Ivan Berk
- Marc Elliot Berman
- Jacey Carol Bullens
- Susan Theresa Ceurvels
- Kevin Crotty
- Willard Manning Daggett
- Ingrid Mary Elizabeth De Baintner
All providers in Dover, MA · Massage Therapist in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.