Healthcare Provider Details

I. General information

NPI: 1740640655
Provider Name (Legal Business Name): MASSAGE CENTER OF NIAGARA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 PORTAGE RD
LEWISTON NY
14092-1700
US

IV. Provider business mailing address

907 91ST ST
NIAGARA FALLS NY
14304-3533
US

V. Phone/Fax

Practice location:
  • Phone: 716-940-0411
  • Fax: 716-285-0803
Mailing address:
  • Phone: 716-940-0411
  • Fax: 716-285-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: GINA PUGLISI
Title or Position: OWNER
Credential: LMT
Phone: 716-940-0411