Provider Demographics
NPI:1073162210
Name:MWG MASSAGE THERAPIES PC
Entity Type:Organization
Organization Name:MWG MASSAGE THERAPIES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRAF
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:631-707-4554
Mailing Address - Street 1:41 SAXON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7009
Mailing Address - Country:US
Mailing Address - Phone:631-707-4554
Mailing Address - Fax:
Practice Address - Street 1:41 SAXON AVE STE A
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7009
Practice Address - Country:US
Practice Address - Phone:631-707-4554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty