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General NPI Number Information
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NPI Number | 1174078687
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Entity Type | Organization
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Legal Business Name | LYPOSSAGE A THERAPEUTIC & MEDICAL MASSAGE
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 716 CLIFTON AVE
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City | NEWARK
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State | NJ
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Zip | 07104-3102
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Country | US
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Telephone | 862-944-5416
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Fax |
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Provider Business Mailing Address
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Address Line | 716 CLIFTON AVE
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City | NEWARK
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State | NJ
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Zip | 07104-3102
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Country | US
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Telephone | 862-944-5416
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Fax |
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Authorized Official
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Title or Position | LYPOSSAGE PRACTITIONER
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Name | RENEE Y RANSDELL
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Credential | LP,MMP
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Telephone | 862-944-5416
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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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