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General NPI Number Information
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NPI Number | 1699970236
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Entity Type | Organization
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Legal Business Name | MONTGOMERY MASSAGE THERAPY GROUP, P.C.
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 WARD ST SUITE F.
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City | MONTGOMERY
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State | NY
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Zip | 12549-1248
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Country | US
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Telephone | 845-457-2729
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Fax | 845-457-8159
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Provider Business Mailing Address
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Address Line | 79 W CORBETT RD
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City | MONTGOMERY
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State | NY
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Zip | 12549-1923
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Country | US
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Telephone | 845-457-2729
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Fax | 845-457-8159
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Authorized Official
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Title or Position | OFFICER
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Name | MS. ANGELA MARIE PATRUNO
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Credential | LMT
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Telephone | 845-457-2729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 020663
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License Number State | NY
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