MEDICARE: JULIE SARAH WITCZAK 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	033575	NY

General Provider Information

NPI Number	:	1336998251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE SARAH WITCZAK LMT

Provider Business Mailing Address
First Line	:	73 LAKE AVE
Second Line	:
City	:	LANCASTER
State	:	NY
Zip	:	14086-2641
Country	:	US
Telephone Number	:	813-532-6464
Fax Number	:

Provider Business Practice Location Address
First Line	:	2360 SWEET HOME RD STE 8
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14228-2331
Country	:	US
Telephone Number	:	716-547-9704
Fax Number	:

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

Provider Enumeration Date	:	05/14/2024
Last Update Date	:	05/14/2024

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