Provider Demographics
NPI:1023765864
Name:ADVANCED MEDICAL MASSAGE & WELLNESS
Entity type:Organization
Organization Name:ADVANCED MEDICAL MASSAGE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-935-1390
Mailing Address - Street 1:184 PLEASANT VALLEY ST STE 1-204
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5855
Mailing Address - Country:US
Mailing Address - Phone:978-935-1390
Mailing Address - Fax:978-737-3510
Practice Address - Street 1:184 PLEASANT VALLEY ST STE 1-204
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5855
Practice Address - Country:US
Practice Address - Phone:978-935-1390
Practice Address - Fax:978-737-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175L00000XOther Service ProvidersHomeopathGroup - Multi-Specialty