MEDICARE: MASSAGE CENTER OF NIAGARA, LLC

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	:	1740640655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASSAGE CENTER OF NIAGARA, LLC

Provider Business Mailing Address
First Line	:	907 91ST ST
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-3533
Country	:	US
Telephone Number	:	716-940-0411
Fax Number	:	716-285-0803

Provider Business Practice Location Address
First Line	:	225 PORTAGE RD
Second Line	:
City	:	LEWISTON
State	:	NY
Zip	:	14092-1700
Country	:	US
Telephone Number	:	716-940-0411
Fax Number	:	716-285-0803

Authorized Official
Title or Position	:	OWNER
Name	:	GINA PUGLISI
Credential	:	LMT
Telephone Number	:	716-940-0411

Provider Enumeration Date	:	03/04/2016
Last Update Date	:	10/18/2016

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