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General NPI Number Information
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NPI Number | 1689258147
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Entity Type | Organization
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Legal Business Name | HOLBROOK MEDICAL MASSAGE INC.
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 1480 BROADWAY AVE
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City | HOLBROOK
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State | NY
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Zip | 11741-5412
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Country | US
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Telephone | 516-480-0507
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Fax |
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Provider Business Mailing Address
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Address Line | 58 1ST AVE
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City | MEDFORD
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State | NY
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Zip | 11763-3837
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Country | US
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Telephone | 631-983-7659
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTONIETTA COLON
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Credential | LMT
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Telephone | 631-983-7659
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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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