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General NPI Number Information
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NPI Number | 1790128288
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Entity Type | Organization
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Legal Business Name | LEA ANI KAISER DBA BIRCH
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 04/15/2013
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Provider Practice Location Address
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Address Line | 73 CROWN ST
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City | KINGSTON
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State | NY
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Zip | 12401-3833
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Country | US
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Telephone | 845-331-7139
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Fax |
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Provider Business Mailing Address
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Address Line | 73 CROWN ST
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City | KINGSTON
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State | NY
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Zip | 12401-3833
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Country | US
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Telephone | 845-331-7139
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEA ANI KAISER
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Credential |
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Telephone | 845-331-7139
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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 | 017973
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License Number State | NY
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