Healthcare Provider Details

I. General information

NPI: 1669303228
Provider Name (Legal Business Name): LORI ROSSI LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 DANBY RD SUITE 201-O
ITHACA NY
14850
US

IV. Provider business mailing address

17 JOHNSON ST
FREEVILLE NY
13068-9818
US

V. Phone/Fax

Practice location:
  • Phone: 607-708-0279
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number021165
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: