MEDICARE: ROWAN JANISZEWSKI 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	030461-01	NY
2	225700000X	Massage Therapist	030461-1	NY

General Provider Information

NPI Number	:	1295223352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROWAN JANISZEWSKI LMT

Provider Business Mailing Address
First Line	:	1174 MOUNT HOPE AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2911
Country	:	US
Telephone Number	:	585-445-8584
Fax Number	:	585-445-8605

Provider Business Practice Location Address
First Line	:	1577 W RIDGE RD STE 208
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14615-2511
Country	:	US
Telephone Number	:	585-770-8361
Fax Number	:

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

Provider Enumeration Date	:	04/24/2018
Last Update Date	:	10/30/2023

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