Healthcare Provider Details

I. General information

NPI: 1710455530
Provider Name (Legal Business Name): ESCAPE AWAY MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 MAIN ST STE 202
NEW YORK MILLS NY
13417-1489
US

IV. Provider business mailing address

587 MAIN ST STE 202
NEW YORK MILLS NY
13417-1489
US

V. Phone/Fax

Practice location:
  • Phone: 315-768-1155
  • Fax:
Mailing address:
  • Phone: 315-768-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. DANIELLE E. BARRES
Title or Position: GENERAL MANAGER
Credential:
Phone: 315-941-1895