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General NPI Number Information
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NPI Number | 1679077424
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Entity Type | Organization
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Legal Business Name | I KNEADED THIS
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 6454 MONTGOMERY ST
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City | RHINEBECK
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State | NY
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Zip | 12572-1360
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Country | US
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Telephone | 845-337-1266
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Fax |
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Provider Business Mailing Address
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Address Line | 95 SPRUCE LN
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City | CLINTON CORNERS
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State | NY
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Zip | 12514-2623
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Country | US
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Telephone | 845-242-4112
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THERESA PALMER
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Credential | MASSAGE THERAPIST
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Telephone | 845-337-1266
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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 | 015353-1
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License Number State | NY
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