Provider Demographics
NPI:1699076075
Name:KRUPA-FOY, MARY JANE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:KRUPA-FOY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4820
Mailing Address - Country:US
Mailing Address - Phone:781-961-9242
Mailing Address - Fax:
Practice Address - Street 1:63 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4820
Practice Address - Country:US
Practice Address - Phone:781-961-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2681172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist