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General NPI Number Information
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NPI Number | 1639986862
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Entity Type | Individual
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Provider Name | MICHAEL MARRERA LMT
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Gender | Male
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 2206 31ST ST
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City | ASTORIA
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State | NY
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Zip | 11105-2714
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Country | US
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Telephone | 347-231-6969
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Fax |
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Provider Business Mailing Address
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Address Line | 1146 WELLING CT APT 2R
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City | ASTORIA
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State | NY
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Zip | 11102-4482
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Country | US
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Telephone | 347-231-6969
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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 | 030995-01
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License Number State | NY
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