Provider Demographics
NPI:1013799725
Name:DEMICK, COLIN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:DEMICK
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 THORNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-8454
Mailing Address - Country:US
Mailing Address - Phone:518-421-7370
Mailing Address - Fax:
Practice Address - Street 1:98 WOLF RD STE 15
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1226
Practice Address - Country:US
Practice Address - Phone:518-941-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028312-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist