=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609413020
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R & L INVESTED CAPITAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2019
-----------------------------------------------------
Last Update Date | 12/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 654 WATERVLIET SHAKER RD
-----------------------------------------------------
City | LATHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12110-3618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-785-7258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 184 STEADWELL RD
-----------------------------------------------------
City | AMSTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12010-7507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-424-7917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROBERT DUFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-785-7258
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------