Provider Demographics
NPI:1679868764
Name:MARY DITTENHAUSER-MASSAGE THERAPY, PC
Entity Type:Organization
Organization Name:MARY DITTENHAUSER-MASSAGE THERAPY, PC
Other - Org Name:A QUIET SPACE MASSAGE STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DITTENHAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:716-639-0550
Mailing Address - Street 1:6209 TRANSIT RD FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1892
Mailing Address - Country:US
Mailing Address - Phone:716-639-0550
Mailing Address - Fax:716-639-0550
Practice Address - Street 1:6209 TRANSIT RD FL 2
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1892
Practice Address - Country:US
Practice Address - Phone:716-639-0550
Practice Address - Fax:716-639-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty