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NPI Code Detail

MEDICARE: SANDY J ULRICH LMT

MEDICARE: SANDY J ULRICH 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
1225700000XMassage Therapist0153231NY

General Provider Information

NPI Number : 1114010022
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDY J ULRICH LMT
Provider Business Mailing Address
First Line : 162 MAIN ST
Second Line :
City : HAMBURG
State : NY
Zip : 14075-4917
Country : US
Telephone Number : 716-627-4704
Fax Number :
Provider Business Practice Location Address
First Line : 162 MAIN ST
Second Line :
City : HAMBURG
State : NY
Zip : 14075-4917
Country : US
Telephone Number : 716-627-4704
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 08/24/2015

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