Provider Demographics
NPI:1104397355
Name:ENDEMANN, CARRIE LYN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYN
Last Name:ENDEMANN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 DRIFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-1848
Mailing Address - Country:US
Mailing Address - Phone:315-750-0555
Mailing Address - Fax:
Practice Address - Street 1:181 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2829
Practice Address - Country:US
Practice Address - Phone:315-569-6579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018594225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist