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NPI Code Detail

MEDICARE: CHEKESHA ENNIS LMT

MEDICARE: CHEKESHA ENNIS 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
1225700000XMassage Therapist030919NY

General Provider Information

NPI Number : 1891457263
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHEKESHA ENNIS LMT
Provider Business Mailing Address
First Line : 854 OCEAN AVE APT 6C
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-5940
Country : US
Telephone Number : 718-623-2100
Fax Number :
Provider Business Practice Location Address
First Line : 854 OCEAN AVE APT 6C
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-5940
Country : US
Telephone Number : 718-469-3386
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2021
Last Update Date : 10/12/2021

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Directions to “ CHEKESHA ENNIS LMT” Practice Location

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