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General NPI Number Information
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NPI Number | 1649091216
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Entity Type | Organization
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Legal Business Name | ELEVATE MASSAGE & BODYWORKS CORP
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 527 TOWNLINE RD STE 200
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City | HAUPPAUGE
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State | NY
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Zip | 11788-2833
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Country | US
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Telephone | 631-943-1243
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Fax |
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Provider Business Mailing Address
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Address Line | 765 VAN BUREN AVE
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City | WEST ISLIP
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State | NY
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Zip | 11795-1337
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Country | US
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Telephone | 631-943-1243
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | PAULA KOLANO
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Credential | LMT, MLD-C
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Telephone | 631-943-1243
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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 |
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License Number State |
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