MEDICARE: ALYSSA GLICA LMT, CHHC

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	025377-1	NY

General Provider Information

NPI Number	:	1821575408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA GLICA LMT, CHHC

Provider Business Mailing Address
First Line	:	116 INDEPENDENCE AVE
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-1333
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 FORT SALONGA RD STE 2A
Second Line	:
City	:	NORTHPORT
State	:	NY
Zip	:	11768-1465
Country	:	US
Telephone Number	:	631-343-9194
Fax Number	:

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

Provider Enumeration Date	:	07/25/2018
Last Update Date	:	07/25/2018

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