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General NPI Number Information
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NPI Number | 1093516809
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Entity Type | Organization
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Legal Business Name | IRTA MASSAGE
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 1363 VETERANS HWY
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City | HAUPPAUGE
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State | NY
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Zip | 11788-3046
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Country | US
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Telephone | 631-882-2517
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Fax |
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Provider Business Mailing Address
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Address Line | 106 W 5TH ST
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City | RONKONKOMA
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State | NY
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Zip | 11779-3843
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IRTA MASSAGE
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Credential | LMT
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Telephone | 631-882-2517
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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 |
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License Number State |
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