Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 014927-1 | NY |
NPI | 1003003377 |
---|---|
Provider Name | Kathleen Prendergast |
First Address | West Falls, NY 14170-9611 |
Second Address | Springville, NY 14141-1442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2007 |
Last Update Date | 01/10/2007 |