Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 019954 | NY |
NPI | 1013530450 |
---|---|
Provider Name | Lori Dawn Geiger |
First Address | Gardiner, NY 12525-5138 |
Second Address | Montgomery, NY 12549-1112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2020 |
Last Update Date | 20/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019954 | MASSAGE THERAPY (01) | NY |