MEDICARE: JOSLYN FODGE LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	029345-1	NY

General Provider Information

NPI Number	:	1144851387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSLYN FODGE LMT

Provider Business Mailing Address
First Line	:	482A MIDDLE GROVE RD
Second Line	:
City	:	MIDDLE GROVE
State	:	NY
Zip	:	12850-1108
Country	:	US
Telephone Number	:	518-366-6470
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 RAILROAD PL STE 101A
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-3058
Country	:	US
Telephone Number	:	518-366-6470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	01/27/2020

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