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General NPI Number Information
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NPI Number | 1851662035
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Entity Type | Organization
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Legal Business Name | A NEW LEAF MASSAGE THERAPY, P.C.
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 6179 W QUAKER ST
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City | ORCHARD PARK
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State | NY
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Zip | 14127-2640
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Country | US
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Telephone | 716-207-9529
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Fax |
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Provider Business Mailing Address
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Address Line | 6179 W QUAKER ST
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City | ORCHARD PARK
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State | NY
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Zip | 14127-2640
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Country | US
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Telephone | 716-207-9529
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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 | MRS. SHAWNA HUNT
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Credential | L.M.T.
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Telephone | 716-207-9529
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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 | 016635-1
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License Number State | NY
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