Provider Demographics
NPI:1356628911
Name:WELLSPRINGS MASSAGE THERAPY LLC
Entity Type:Organization
Organization Name:WELLSPRINGS MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT AND BUSINESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:HUZYK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:585-957-6776
Mailing Address - Street 1:3183 CHILI AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-5409
Mailing Address - Country:US
Mailing Address - Phone:585-889-7001
Mailing Address - Fax:
Practice Address - Street 1:3183 CHILI AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5409
Practice Address - Country:US
Practice Address - Phone:585-889-7001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022947225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty