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General NPI Number Information
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NPI Number | 1467126201
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Entity Type | Organization
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Legal Business Name | BALANCE FOR LIFE: MIND, BODY & SOUL HEALING
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 248 MIDDLE COUNTRY ROAD SUITE 16B
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City | SEIDEN
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State | NY
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Zip | 11784-2570
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Country | US
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Telephone | 631-736-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 248 MIDDLE COUNTRY ROAD SUITE 16B
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City | SEIDEN
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State | NY
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Zip | 11784-2570
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Country | US
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Telephone | 631-736-9999
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Fax |
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Authorized Official
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Title or Position | OWNER/ LICENSED MASSAGE THERAPIST
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Name | MS. KATHERINE MONGIELLO
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Credential | LMT
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Telephone | 631-736-9999
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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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