Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 023062-1 | NY |
NPI | 1003117813 |
---|---|
Provider Name | Tyler Fedigan |
First Address | Saratoga Springs, NY 12866-2529 |
Second Address | Saratoga Springs, NY 12866-2529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2010 |
Last Update Date | 10/11/2010 |