Provider Demographics
NPI:1710561980
Name:MEDINA, SAUL (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:SAUL
Middle Name:
Last Name:MEDINA
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:MR
Other - First Name:SAUL
Other - Middle Name:
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:34 GARNET STREET
Mailing Address - Street 2:APT 4 LR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231
Mailing Address - Country:US
Mailing Address - Phone:516-754-3432
Mailing Address - Fax:
Practice Address - Street 1:34 GARNET STREET
Practice Address - Street 2:APT 4 LR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231
Practice Address - Country:US
Practice Address - Phone:516-754-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032569225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist