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General NPI Number Information
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NPI Number | 1336629179
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Entity Type | Organization
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Legal Business Name | CAMILLUS MASSAGE THERAPY PC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 4906 W GENESEE ST
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City | CAMILLUS
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State | NY
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Zip | 13031-2325
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Country | US
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Telephone | 315-552-0552
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Fax |
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Provider Business Mailing Address
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Address Line | 4906 W GENESEE ST
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City | CAMILLUS
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State | NY
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Zip | 13031-2325
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Country | US
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Telephone | 315-552-0552
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER GREGORY HESS
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Credential | LMT
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Telephone | 315-552-0552
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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 | 119074
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License Number State | NY
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