Individual
TARA CRISTELLE LASCOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MMP
Contact information
Practice address
47-49 CENTRAL ST, PEABODY, MA 01960-4375
(978) 278-3310
Mailing address
47-49 CENTRAL ST, PEABODY, MA 01960-4375
(978) 278-3310
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2875
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2875
STATE OF MA
MA
Enumeration date
11/23/2012
Last updated
11/23/2012
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