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General NPI Number Information
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NPI Number | 1164181830
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Entity Type | Individual
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Provider Name | KIMBERLY HANLEY
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Gender | Female
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Dates
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Enumeration Date | 12/09/2021
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Last Update Date | 12/09/2021
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Provider Practice Location Address
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Address Line | 55 MAPLE AVE STE 306
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4267
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Country | US
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Telephone | 516-639-4925
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Fax |
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Provider Business Mailing Address
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Address Line | 159-70 HARLEM RIVER DR APT 5E
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City | NEW YORK
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State | NY
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Zip | 10039-1031
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Country | US
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Telephone | 918-405-6916
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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 |
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License Number State | NY
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