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General NPI Number Information
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NPI Number | 1174387534
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Entity Type | Organization
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Legal Business Name | BAYPORT THERAPEUTIC MASSAGE PLLC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 730 MONTAUK HWY
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City | BAYPORT
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State | NY
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Zip | 11705-1621
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Country | US
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Telephone | 631-419-6663
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Fax |
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Provider Business Mailing Address
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Address Line | 730 MONTAUK HWY
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City | BAYPORT
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State | NY
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Zip | 11705-1621
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Country | US
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Telephone | 631-991-0052
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ISAR CASTANEDA
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Credential | LMT
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Telephone | 646-352-3792
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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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