Provider Demographics
NPI:1033475538
Name:MIRE ROSE, CHRISTINE (LMT, RYT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:MIRE ROSE
Suffix:
Gender:F
Credentials:LMT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 BLEECKER ST
Mailing Address - Street 2:2R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2602
Mailing Address - Country:US
Mailing Address - Phone:917-365-8693
Mailing Address - Fax:
Practice Address - Street 1:350 BLEECKER ST
Practice Address - Street 2:2R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-2602
Practice Address - Country:US
Practice Address - Phone:917-365-8693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27-017317225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist