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General NPI Number Information
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NPI Number | 1821504846
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Entity Type | Individual
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Provider Name | ANNE MARIE JURENKO HERRON LMT
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Gender | Female
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 12/28/2017
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Provider Practice Location Address
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Address Line | 70 OFFICE PARK WAY BLDG 70
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City | PITTSFORD
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State | NY
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Zip | 14534-1746
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Country | US
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Telephone | 585-205-4478
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Fax |
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Provider Business Mailing Address
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Address Line | 80 DEER PATH DR
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City | ROCHESTER
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State | NY
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Zip | 14612-2862
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Country | US
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Telephone | 585-205-4478
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 011245-1
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License Number State | NY
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