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General NPI Number Information
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NPI Number | 1144663063
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Entity Type | Individual
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Provider Name | STEPHANIE JACQUELINE RADICE LMT
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Gender | Female
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 1961 WEHRLE DR SUITE 7
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-8460
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Country | US
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Telephone | 716-626-4466
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Fax |
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Provider Business Mailing Address
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Address Line | 4591 SOUTHWESTERN BLVD APT C4
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City | HAMBURG
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State | NY
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Zip | 14075-1946
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Country | US
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Telephone | 716-698-7284
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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 | 27 026896
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License Number State | NY
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