Healthcare Provider Details

I. General information

NPI: 1609399484
Provider Name (Legal Business Name): MICHAEL YEMMA LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5977 MAIN ST
WILLIAMSVILLE NY
14221-5740
US

IV. Provider business mailing address

3785 ABBOTT RD
ORCHARD PARK NY
14127-2117
US

V. Phone/Fax

Practice location:
  • Phone: 716-200-0835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number029805
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: