MEDICARE: MYW STUDIO SPA AND FITNESS 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	:	1952966137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYW STUDIO SPA AND FITNESS LLC

Provider Business Mailing Address
First Line	:	113 FOREST AVE
Second Line	:
City	:	LOCUST VALLEY
State	:	NY
Zip	:	11560-1738
Country	:	US
Telephone Number	:	516-723-9874
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 FOREST AVE
Second Line	:
City	:	LOCUST VALLEY
State	:	NY
Zip	:	11560-1738
Country	:	US
Telephone Number	:	516-723-9874
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARGARITA ZAHLODINA
Credential	:
Telephone Number	:	516-723-9874

Provider Enumeration Date	:	05/03/2019
Last Update Date	:	05/03/2019

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Directions to “MYW STUDIO SPA AND FITNESS LLC ” Practice Location

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