Provider Demographics
NPI:1285966341
Name:WINGS MOBILE MASSAGE & BODYWORK
Entity type:Organization
Organization Name:WINGS MOBILE MASSAGE & BODYWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROOKS-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:508-332-6522
Mailing Address - Street 1:1191 N MAIN ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2135
Mailing Address - Country:US
Mailing Address - Phone:508-332-6522
Mailing Address - Fax:339-987-4847
Practice Address - Street 1:1191 N MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2135
Practice Address - Country:US
Practice Address - Phone:508-332-6522
Practice Address - Fax:339-987-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-31
Last Update Date:2010-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6947225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty