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General NPI Number Information
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NPI Number | 1689713091
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Entity Type | Individual
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Provider Name | PAUL WRISLEY LMT
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 215 SPENCERPORT RD
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City | ROCHESTER
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State | NY
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Zip | 14606-5209
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Country | US
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Telephone | 585-755-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 268 BURNT MILL RD
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City | CHURCHVILLE
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State | NY
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Zip | 14428-9405
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Country | US
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Telephone | 585-293-3809
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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 | 017677
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License Number State | NY
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