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General NPI Number Information
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NPI Number | 1881131704
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Entity Type | Individual
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Provider Name | TINA YOUNGERS LMT
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Gender | Female
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 27 EDWARD ST
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City | ARCADE
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State | NY
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Zip | 14009-1012
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Country | US
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Telephone | 585-492-4225
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Fax |
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Provider Business Mailing Address
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Address Line | 2370 CLARK RD
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City | BLISS
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State | NY
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Zip | 14024-9747
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Country | US
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Telephone | 716-432-7431
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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 | 029807-1
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License Number State | NY
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