Healthcare Provider Details

I. General information

NPI: 1851956676
Provider Name (Legal Business Name): KOA INTUITIVE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 ROUTE 17M STE 1
GOSHEN NY
10924-5236
US

IV. Provider business mailing address

2002 ROUTE 17M STE 1
GOSHEN NY
10924-5236
US

V. Phone/Fax

Practice location:
  • Phone: 845-551-8772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LIZA BOVE
Title or Position: OWNER
Credential:
Phone: 845-551-8772