Healthcare Provider Details

I. General information

NPI: 1245484419
Provider Name (Legal Business Name): MICHELLE M MIORI L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 BROADWAY ST
ALDEN NY
14004-1466
US

IV. Provider business mailing address

13500 BROADWAY ST
ALDEN NY
14004-1466
US

V. Phone/Fax

Practice location:
  • Phone: 716-380-7153
  • Fax: 716-937-6453
Mailing address:
  • Phone: 716-380-7153
  • Fax: 716-937-6453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number022182
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: