MEDICARE: VICTOR B. WEISS 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	033128	NY

General Provider Information

NPI Number	:	1336865542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR B. WEISS LMT

Provider Business Mailing Address
First Line	:	PO BOX 77
Second Line	:
City	:	BRIDGEHAMPTON
State	:	NY
Zip	:	11932-0077
Country	:	US
Telephone Number	:	631-839-0388
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 BAY ST
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-3104
Country	:	US
Telephone Number	:	631-839-0388
Fax Number	:

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

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	10/19/2022

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