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General NPI Number Information
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NPI Number | 1710231329
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Entity Type | Organization
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Legal Business Name | A PEACEFUL PATH TO WELLNESS
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 2400 MAIN ST
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City | BUFFALO
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State | NY
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Zip | 14214-2364
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Country | US
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Telephone | 716-598-3607
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 MAIN ST
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City | BUFFALO
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State | NY
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Zip | 14214-2364
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | SUZANNE FUNDALINSKI
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Credential | L.M.T.
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Telephone | 716-598-3607
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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 | 019727-1
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License Number State | NY
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