MEDICARE: ANGELA JESSIE LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	030467-1	NY

General Provider Information

NPI Number	:	1073003737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA JESSIE LMT

Provider Business Mailing Address
First Line	:	1201 COLVIN BLVD STE 5
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1936
Country	:	US
Telephone Number	:	716-218-0675
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 COLVIN BLVD STE 5
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1936
Country	:	US
Telephone Number	:	716-218-0676
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2018
Last Update Date	:	01/06/2026

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