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General NPI Number Information
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NPI Number | 1700330347
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Entity Type | Organization
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Legal Business Name | ATLANTIS PT MASSAGE AND ACUPUNCTURE PLLC
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 466 MORICHES RD
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City | SAINT JAMES
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State | NY
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Zip | 11780-2041
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Country | US
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Telephone | 631-584-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 466 MORICHES RD
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City | SAINT JAMES
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State | NY
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Zip | 11780-2041
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Country | US
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Telephone | 631-584-2323
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JANET MULHALL
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Credential | LMT
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Telephone | 631-584-2323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 004990
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 003371
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 036773
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License Number State | NY
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