MEDICARE: PAULA DECRESCENZO 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	021839	NY

General Provider Information

NPI Number	:	1336310671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA DECRESCENZO LMT

Provider Business Mailing Address
First Line	:	116 SIERRA VISTA LN
Second Line	:
City	:	VALLEY COTTAGE
State	:	NY
Zip	:	10989-2702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 SIERRA VISTA LN
Second Line	:
City	:	VALLEY COTTAGE
State	:	NY
Zip	:	10989-2702
Country	:	US
Telephone Number	:	845-271-9612
Fax Number	:

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

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	07/11/2009

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