Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 27-029070 | NY |
NPI | 1013389774 |
---|---|
Provider Name | Jessica Ferraro |
First Address | Depew, NY 14043-4898 |
Second Address | Depew, NY 14043-4898 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2015 |
Last Update Date | 21/10/2015 |