Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 022365 | NY |
NPI | 1003343393 |
---|---|
Provider Name | Angela Ciliberto |
First Address | East Amherst, NY 14051-2176 |
Second Address | East Amherst, NY 14051-2176 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2017 |
Last Update Date | 17/05/2017 |