=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871077156
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUZ ELENA TURSO MT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2018
-----------------------------------------------------
Last Update Date | 09/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 152 ISLIP AVE STE 23
-----------------------------------------------------
City | ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11751-3225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-277-6767
-----------------------------------------------------
Fax | 631-277-4311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 228 UNION AVE
-----------------------------------------------------
City | HOLBROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11741-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-664-7721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 18KT01231700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------