Healthcare Provider Details

I. General information

NPI: 1184025827
Provider Name (Legal Business Name): PURELY CONNECTED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2982 DELAWARE AVE REAR
KENMORE NY
14217-2324
US

IV. Provider business mailing address

2982 DELAWARE AVE REAR
KENMORE NY
14217-2324
US

V. Phone/Fax

Practice location:
  • Phone: 716-877-2858
  • Fax: 716-877-2859
Mailing address:
  • Phone: 716-877-2858
  • Fax: 716-877-2859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number022871-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number0904
License Number StateNY

VIII. Authorized Official

Name: ERIN ZWACK
Title or Position: OWNER/LICENSED MASSAGE THERAPIST
Credential: LMT
Phone: 716-907-3987