MEDICARE: KNEAD TO ESCAPE, INC.

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	008471	NY

General Provider Information

NPI Number	:	1699939124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNEAD TO ESCAPE, INC.

Provider Business Mailing Address
First Line	:	12 WHITAKER PL
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10304-4120
Country	:	US
Telephone Number	:	917-838-7080
Fax Number	:

Provider Business Practice Location Address
First Line	:	3077 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-4154
Country	:	US
Telephone Number	:	917-838-7080
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MASSAGE THERAPIST
Name	:	MS. CHRISTINE CIPRIANO
Credential	:	L.M.T.
Telephone Number	:	917-838-7080

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	07/14/2008

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