MEDICARE: PNEUMA BALANCE MASSAGE BODYWORK, PLLC

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	025179	NY

General Provider Information

NPI Number	:	1871952325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PNEUMA BALANCE MASSAGE BODYWORK, PLLC

Provider Business Mailing Address
First Line	:	205 MARINE DR APT 2B
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14202-4215
Country	:	US
Telephone Number	:	716-228-9843
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 DELAWARE AVE STE 102
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14202-1807
Country	:	US
Telephone Number	:	716-228-9843
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LIZZIE CORNELIA SNEED
Credential	:	LMT
Telephone Number	:	716-228-9843

Provider Enumeration Date	:	02/12/2016
Last Update Date	:	02/12/2016

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