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General NPI Number Information
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NPI Number | 1740870476
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Entity Type | Organization
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Legal Business Name | REBALANCE MASSAGE, PC
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 585 STEWART AVE STE 408
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City | GARDEN CITY
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State | NY
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Zip | 11530-4701
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Country | US
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Telephone | 516-582-0088
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Fax |
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Provider Business Mailing Address
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Address Line | 244 CLINTON RD
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City | GARDEN CITY
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State | NY
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Zip | 11530-1922
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Country | US
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Telephone | 517-582-0088
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Fax |
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Authorized Official
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Title or Position | LICENSE MASSAGE THERAPIST
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Name | VIRGINIA JOUDEH M
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Credential | LMT
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Telephone | 516-582-0088
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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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