Provider Demographics
NPI:1164773990
Name:SOUND SHORE MASSAGE
Entity Type:Organization
Organization Name:SOUND SHORE MASSAGE
Other - Org Name:SOUND SHORE MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:KERRY-ANN
Authorized Official - Last Name:THORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:914-875-9082
Mailing Address - Street 1:130 MAHOPAC AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:GRANITE SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:10527-1131
Mailing Address - Country:US
Mailing Address - Phone:914-875-9082
Mailing Address - Fax:888-223-9564
Practice Address - Street 1:130 MAHOPAC AVE APT 3
Practice Address - Street 2:
Practice Address - City:GRANITE SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:10527-1131
Practice Address - Country:US
Practice Address - Phone:914-875-9082
Practice Address - Fax:888-223-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0171021225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty