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General NPI Number Information
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NPI Number | 1386044089
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Entity Type | Organization
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Legal Business Name | RENEW WELLNESS
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Dates
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Enumeration Date | 08/29/2014
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Last Update Date | 08/29/2014
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Provider Practice Location Address
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Address Line | 22 BARONE CIR
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City | CHEEKTOWAGA
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State | NY
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Zip | 14225-3617
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Country | US
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Telephone | 716-628-7666
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Fax |
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Provider Business Mailing Address
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Address Line | 22 BARONE CIR
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City | CHEEKTOWAGA
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State | NY
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Zip | 14225-3617
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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 | LICENSED MASSAGE THERAPIST
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Name | LACIE J TURGEON
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Credential | LMT
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Telephone | 716-628-7666
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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 | 0278351
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License Number State | NY
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