Individual
DMITRIY GERVAGIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
44 HIGH ST, NEWTON, MA 02464-1232
(617) 828-4516
Mailing address
44 HIGH ST, NEWTON, MA 02464-1232
(617) 828-4516
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10680
MA
Other
Enumeration date
06/25/2012
Last updated
06/25/2012
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