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General NPI Number Information
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NPI Number | 1548566763
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Entity Type | Organization
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Legal Business Name | SARATOGA SPRINGS MASSAGE THERAPY LLC
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Dates
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Enumeration Date | 02/05/2011
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Last Update Date | 02/05/2011
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Provider Practice Location Address
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Address Line | 188 LAKE AVE
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2529
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Country | US
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Telephone | 518-859-5922
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Fax |
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Provider Business Mailing Address
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Address Line | 188 LAKE AVE
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2529
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Country | US
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Telephone | 518-859-5922
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Fax |
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Authorized Official
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Title or Position | MANAGER/LICENSED MASSAGE THERAPIST
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Name | TYLER FEDIGAN
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Credential | LMT
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Telephone | 518-859-5922
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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 | 27-023062
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License Number State | NY
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