Healthcare Provider Details

I. General information

NPI: 1285135442
Provider Name (Legal Business Name): KNOTS & BOLTS THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W 57TH ST APT B
NEW YORK NY
10019-1753
US

IV. Provider business mailing address

6911 YELLOWSTONE BLVD APT B32
FOREST HILLS NY
11375-3789
US

V. Phone/Fax

Practice location:
  • Phone: 917-599-2179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004557
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number019417
License Number StateNY

VIII. Authorized Official

Name: SUSAN HOFMANN-LEVIN
Title or Position: OWNER
Credential: L.AC, LMT
Phone: 631-240-4196