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General NPI Number Information
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NPI Number | 1285135442
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Entity Type | Organization
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Legal Business Name | KNOTS & BOLTS THERAPY PLLC
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 415 W 57TH ST APT B
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City | NEW YORK
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State | NY
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Zip | 10019-1753
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Country | US
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Telephone | 917-599-2179
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Fax |
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Provider Business Mailing Address
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Address Line | 6911 YELLOWSTONE BLVD APT B32
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City | FOREST HILLS
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State | NY
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Zip | 11375-3789
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN HOFMANN-LEVIN
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Credential | L.AC, LMT
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Telephone | 631-240-4196
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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 | 019417
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 004557
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License Number State | NY
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