Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 01970 | NY |
NPI | 1013471127 |
---|---|
Provider Name | Natalie Nicole Lugo |
First Address | Baiting Hollow, NY 11933-1106 |
Second Address | Baiting Hollow, NY 11933-1106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2019 |
Last Update Date | 23/01/2019 |