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General NPI Number Information
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NPI Number | 1962219386
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Entity Type | Organization
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Legal Business Name | BLESSED BRIDAL AND BODY
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 4 MAIN ST
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City | CORTLAND
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State | NY
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Zip | 13045-2608
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Country | US
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Telephone | 607-279-2888
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Fax |
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Provider Business Mailing Address
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Address Line | 463 CASWELL RD
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City | FREEVILLE
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State | NY
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Zip | 13068-9723
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Country | US
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Telephone | 607-279-2888
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Fax |
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Authorized Official
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Title or Position | OWNER/ LMT
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Name | VALERIE MEREDITH POTTER SUK
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Credential | LMT
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Telephone | 607-279-2888
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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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