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General NPI Number Information
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NPI Number | 1295232395
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Entity Type | Organization
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Legal Business Name | MASSAGE THERAPY OF BUFFALO
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 10/25/2019
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Provider Practice Location Address
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Address Line | 10225 MAIN ST STE 10A
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City | CLARENCE
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State | NY
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Zip | 14031-2096
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Country | US
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Telephone | 716-427-8634
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Fax | 716-407-3007
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Provider Business Mailing Address
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Address Line | 10225 MAIN ST STE 10A
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City | CLARENCE
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State | NY
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Zip | 14031-2096
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Country | US
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Telephone | 716-427-8634
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Fax | 716-407-3007
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Authorized Official
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Title or Position | LMT
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Name | MARIA CASEY
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Credential |
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Telephone | 716-427-8634
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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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