MEDICARE: ELAINE BROILES 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	020874	NY

General Provider Information

NPI Number	:	1396326732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE BROILES LMT

Provider Business Mailing Address
First Line	:	5 CHELTON AVE
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180-3106
Country	:	US
Telephone Number	:	518-577-5732
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 DELAWARE AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12209-1415
Country	:	US
Telephone Number	:	518-577-5732
Fax Number	:

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

Provider Enumeration Date	:	04/17/2021
Last Update Date	:	04/17/2021

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Directions to “ ELAINE BROILES LMT” Practice Location

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