Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2840 | NY |
NPI | 1003151333 |
---|---|
Provider Name | Dale Montelione Grust |
First Address | New Paltz, NY 12561-2732 |
Second Address | New Paltz, NY 12561-2732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2012 |
Last Update Date | 27/11/2012 |