Provider Demographics
NPI:1568850451
Name:GREEN PASTURES STILL WATERS MASSAGE THERAPY & SPA
Entity Type:Organization
Organization Name:GREEN PASTURES STILL WATERS MASSAGE THERAPY & SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ZIMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:716-435-0020
Mailing Address - Street 1:142 LORELEE DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-4325
Mailing Address - Country:US
Mailing Address - Phone:716-435-0020
Mailing Address - Fax:
Practice Address - Street 1:142 LORELEE DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-4325
Practice Address - Country:US
Practice Address - Phone:716-435-0020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018786225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1225201437OtherNPI - INDIVIDUAL
NY018786OtherNYS LMT LICENSE