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General NPI Number Information
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NPI Number | 1629548623
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Entity Type | Individual
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Provider Name | LINDA CAROL GONCALVES LMT
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Gender | Female
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Dates
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Enumeration Date | 12/03/2018
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 348 JERICHO TPKE
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City | SYOSSET
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State | NY
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Zip | 11791-4507
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Country | US
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Telephone | 516-921-3468
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Fax |
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Provider Business Mailing Address
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Address Line | 478 W MAIN ST
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City | HUNTINGTON
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State | NY
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Zip | 11743-3137
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Country | US
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Telephone | 631-525-7476
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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 | 9454920
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License Number State | NY
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