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General NPI Number Information
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NPI Number | 1497099295
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Entity Type | Individual
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Provider Name | TRACY CLARK-CHERRY LMT
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Gender | Female
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 10 MAIN ST MOSAIC BODYWORKS, WATER STREET MARKET, SUITE 325
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City | NEW PALTZ
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State | NY
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Zip | 12561-1762
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Country | US
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Telephone | 845-706-6692
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Fax |
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Provider Business Mailing Address
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Address Line | 180 HORSENDEN RD
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City | NEW PALTZ
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State | NY
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Zip | 12561-3132
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Country | US
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Telephone | 845-706-6692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 005315-2
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License Number State | NY
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