Provider Demographics
NPI:1295232395
Name:MASSAGE THERAPY OF BUFFALO
Entity Type:Organization
Organization Name:MASSAGE THERAPY OF BUFFALO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-427-8634
Mailing Address - Street 1:10225 MAIN ST STE 10A
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-2096
Mailing Address - Country:US
Mailing Address - Phone:716-427-8634
Mailing Address - Fax:716-407-3007
Practice Address - Street 1:10225 MAIN ST STE 10A
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-2096
Practice Address - Country:US
Practice Address - Phone:716-427-8634
Practice Address - Fax:716-407-3007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty