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General NPI Number Information
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NPI Number | 1316222672
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Entity Type | Individual
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Provider Name | MICHELLE RENAR L.M.T
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Gender | Female
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 291 WALL ST SUITE 2 A
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City | KINGSTON
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State | NY
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Zip | 12401-3849
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Country | US
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Telephone | 845-331-5759
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Fax |
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Provider Business Mailing Address
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Address Line | 291 WALL ST SUITE 2 A
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City | KINGSTON
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State | NY
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Zip | 12401-3849
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Country | US
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Telephone | 845-331-5759
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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 | 27017092
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License Number State | NY
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