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General NPI Number Information
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NPI Number | 1033436043
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Entity Type | Organization
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Legal Business Name | THE BODYSATTVA
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 281 MAIN ST
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City | NORTHPORT
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State | NY
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Zip | 11768-1771
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Country | US
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Telephone | 631-922-1834
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Fax |
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Provider Business Mailing Address
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Address Line | 281 MAIN ST
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City | NORTHPORT
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State | NY
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Zip | 11768-1771
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Country | US
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Telephone | 631-922-1834
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANA LEE LEVIN
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Credential | LMT
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Telephone | 631-922-1834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 27-013694
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License Number State | NY
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