Healthcare Provider Details

I. General information

NPI: 1194142844
Provider Name (Legal Business Name): MICHAEL URBAN II LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 SOUTH AVE
ROCHESTER NY
14620-2252
US

IV. Provider business mailing address

728 SOUTH AVE
ROCHESTER NY
14620-2252
US

V. Phone/Fax

Practice location:
  • Phone: 585-388-4325
  • Fax:
Mailing address:
  • Phone: 585-388-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number027029-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: