Provider Demographics
NPI:1548566763
Name:SARATOGA SPRINGS MASSAGE THERAPY LLC
Entity Type:Organization
Organization Name:SARATOGA SPRINGS MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:518-859-5922
Mailing Address - Street 1:188 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2529
Mailing Address - Country:US
Mailing Address - Phone:518-859-5922
Mailing Address - Fax:
Practice Address - Street 1:188 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2529
Practice Address - Country:US
Practice Address - Phone:518-859-5922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-05
Last Update Date:2011-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27-023062225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty