Healthcare Provider Details

I. General information

NPI: 1447359211
Provider Name (Legal Business Name): GARY R MERRITT MASSAGE THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 GOODMAN ST N
ROCHESTER NY
14607-1501
US

IV. Provider business mailing address

39 GOODMAN ST N
ROCHESTER NY
14607-1501
US

V. Phone/Fax

Practice location:
  • Phone: 585-721-1027
  • Fax: 585-420-9138
Mailing address:
  • Phone: 585-721-1027
  • Fax: 585-420-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number011528
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: