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General NPI Number Information
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NPI Number | 1154709145
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Entity Type | Organization
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Legal Business Name | SAMARRA MASSAGE
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 05/11/2015
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Provider Practice Location Address
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Address Line | 1344 UNIVERSITY AVE
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City | ROCHESTER
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State | NY
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Zip | 14607-1656
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Country | US
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Telephone | 585-278-8402
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Fax |
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Provider Business Mailing Address
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Address Line | 1815 ROCHESTER ST
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City | LIMA
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State | NY
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Zip | 14485-9501
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Country | US
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Telephone | 585-278-8402
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEN SAMARRA
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Credential | LMT
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Telephone | 585-278-8402
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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 | 025579
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License Number State | NY
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