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General NPI Number Information
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NPI Number | 1033798491
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Entity Type | Individual
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Provider Name | DALE LAFATA LMT
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Gender | Female
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 1147 DEER PARK AVE
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City | NORTH BABYLON
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State | NY
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Zip | 11703-3103
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Country | US
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Telephone | 631-402-4680
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Fax |
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Provider Business Mailing Address
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Address Line | 18 WILLIAM AVE
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City | EAST ISLIP
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State | NY
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Zip | 11730-2305
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Country | US
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Telephone | 631-224-7343
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 012274-01
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License Number State | NY
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