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General NPI Number Information
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NPI Number | 1467120410
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Entity Type | Organization
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Legal Business Name | BEAUTIFUL MOUNTAIN MASSAGE THERAPY P.C
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 18341 DUNLOP AVE
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City | JAMAICA
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State | NY
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Zip | 11412-1511
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Country | US
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Telephone | 718-513-9543
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Fax |
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Provider Business Mailing Address
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Address Line | 20417 HILLSIDE AVE STE 209
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City | HOLLIS
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State | NY
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Zip | 11423-2213
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Country | US
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Telephone | 718-513-9543
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. NICOLE BEAUMONT
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Credential | LMT CMMT
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Telephone | 718-513-9543
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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 |
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