MEDICARE: LEANNA FOURNIOTIS 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	025995	NY

General Provider Information

NPI Number	:	1932754850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANNA FOURNIOTIS LMT

Provider Business Mailing Address
First Line	:	19636 45TH AVE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-3508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8003 211TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-1012
Country	:	US
Telephone Number	:	646-637-6641
Fax Number	:

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

Provider Enumeration Date	:	08/07/2019
Last Update Date	:	08/07/2019

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