Provider Demographics
NPI:1265841472
Name:SPECIALIZED THERAPEUTIC MASSAGE OF CNY
Entity Type:Organization
Organization Name:SPECIALIZED THERAPEUTIC MASSAGE OF CNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BRAHS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:315-569-3472
Mailing Address - Street 1:24 CAROL DR
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2229
Mailing Address - Country:US
Mailing Address - Phone:315-569-3472
Mailing Address - Fax:
Practice Address - Street 1:112 DEWITT ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2890
Practice Address - Country:US
Practice Address - Phone:315-569-3472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026057261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation