MEDICARE: MK MASSAGE THERAPY

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

General Provider Information

NPI Number	:	1407490212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MK MASSAGE THERAPY

Provider Business Mailing Address
First Line	:	3815 SEA GATE AVE # 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1240
Country	:	US
Telephone Number	:	917-693-4237
Fax Number	:

Provider Business Practice Location Address
First Line	:	3815 SEA GATE AVE # 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1240
Country	:	US
Telephone Number	:	917-693-4237
Fax Number	:

Authorized Official
Title or Position	:	MT
Name	:	MAKSIM KRASNYUK
Credential	:	LMT
Telephone Number	:	917-693-4237

Provider Enumeration Date	:	11/05/2019
Last Update Date	:	11/05/2019

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Directions to “MK MASSAGE THERAPY ” Practice Location

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