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General NPI Number Information
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NPI Number | 1992511679
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Entity Type | Organization
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Legal Business Name | WEST MEADOW MASSAGE THERAPY PC
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 159 ROUTE 25A
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City | MILLER PLACE
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State | NY
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Zip | 11764-2458
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Country | US
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Telephone | 631-862-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 159 ROUTE 25A
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City | MILLER PLACE
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State | NY
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Zip | 11764-2458
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUAN LIN
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Credential |
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Telephone | 631-703-1191
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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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