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General NPI Number Information
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NPI Number | 1952966137
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Entity Type | Organization
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Legal Business Name | MYW STUDIO SPA AND FITNESS LLC
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Dates
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Enumeration Date | 05/03/2019
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | 113 FOREST AVE
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City | LOCUST VALLEY
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State | NY
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Zip | 11560-1738
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Country | US
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Telephone | 516-723-9874
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Fax |
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Provider Business Mailing Address
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Address Line | 113 FOREST AVE
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City | LOCUST VALLEY
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State | NY
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Zip | 11560-1738
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Country | US
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Telephone | 516-723-9874
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARGARITA ZAHLODINA
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Credential |
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Telephone | 516-723-9874
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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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