Provider Demographics
NPI:1881388825
Name:ROWELL, CONSTANCE LASHA
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:LASHA
Last Name:ROWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28A LIBERTY PL APT A
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3768
Mailing Address - Country:US
Mailing Address - Phone:781-428-1448
Mailing Address - Fax:
Practice Address - Street 1:25 SCHOOL ST STE B2
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6665
Practice Address - Country:US
Practice Address - Phone:671-689-0440
Practice Address - Fax:671-689-0420
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11332-MT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist