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General NPI Number Information
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NPI Number | 1922970938
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Entity Type | Organization
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Legal Business Name | BODY LOGIC MASSAGE THERAPY PLLC
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 252 E PARK AVE
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City | LONG BEACH
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State | NY
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Zip | 11561-3521
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Country | US
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Telephone | 516-431-5400
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Fax | 516-604-3585
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Provider Business Mailing Address
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Address Line | 252 E PARK AVE
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City | LONG BEACH
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State | NY
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Zip | 11561-3521
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Country | US
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Telephone | 516-431-5400
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Fax | 516-604-3585
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Authorized Official
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Title or Position | OWNER
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Name | MELANIE WAGMAN
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Credential | LMT
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Telephone | 516-431-5400
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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 |
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License Number State |
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