Provider Demographics
NPI:1689902702
Name:TAYLOR, MARTHA ANN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2 CORACI BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-4833
Mailing Address - Country:US
Mailing Address - Phone:631-281-0606
Mailing Address - Fax:631-281-0990
Practice Address - Street 1:2 CORACI BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-4833
Practice Address - Country:US
Practice Address - Phone:631-281-0606
Practice Address - Fax:631-281-0990
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011597-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist