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General NPI Number Information
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NPI Number | 1144461633
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Entity Type | Individual
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Provider Name | BARBARANN MARTIN MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 03/13/2009
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Last Update Date | 03/13/2009
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Provider Practice Location Address
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Address Line | 551 BROAD ST
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City | WAVERLY
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State | NY
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Zip | 14892-1502
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Country | US
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Telephone | 607-222-0697
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Fax |
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Provider Business Mailing Address
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Address Line | RR 5 BOX 5237
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City | TOWANDA
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State | PA
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Zip | 18848-9378
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Country | US
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Telephone | 570-265-7231
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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 | 017336-1
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License Number State | NY
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