=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336310671
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA DECRESCENZO LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2008
-----------------------------------------------------
Last Update Date | 07/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 SIERRA VISTA LN
-----------------------------------------------------
City | VALLEY COTTAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10989-2702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-271-9612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 SIERRA VISTA LN
-----------------------------------------------------
City | VALLEY COTTAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10989-2702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 021839
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------