Healthcare Provider Details

I. General information

NPI: 1710561980
Provider Name (Legal Business Name): SAUL MEDINA MASSAGE THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SAUL MEDINA MASSAGE THERAPIST

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 GARNET STREET APT 4 LR
BROOKLYN NY
11231
US

IV. Provider business mailing address

34 GARNET STREET APT 4 LR
BROOKLYN NY
11231
US

V. Phone/Fax

Practice location:
  • Phone: 516-754-3432
  • Fax:
Mailing address:
  • Phone: 516-754-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number03256901
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number032569
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: