Healthcare Provider Details

I. General information

NPI: 1265076095
Provider Name (Legal Business Name): VALERIE K KOWALENKO MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 CENTER RD
WEST SENECA NY
14224-2238
US

IV. Provider business mailing address

384 ROWLEY RD
DEPEW NY
14043-4112
US

V. Phone/Fax

Practice location:
  • Phone: 716-901-5818
  • Fax:
Mailing address:
  • Phone: 716-901-5818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number029910-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: