Provider Demographics
NPI:1184025827
Name:PURELY CONNECTED, LLC
Entity type:Organization
Organization Name:PURELY CONNECTED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWACK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:716-907-3987
Mailing Address - Street 1:2982 DELAWARE AVE
Mailing Address - Street 2:REAR
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2324
Mailing Address - Country:US
Mailing Address - Phone:716-877-2858
Mailing Address - Fax:716-877-2859
Practice Address - Street 1:2982 DELAWARE AVE
Practice Address - Street 2:REAR
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2324
Practice Address - Country:US
Practice Address - Phone:716-877-2858
Practice Address - Fax:716-877-2859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0904173C00000X
NY022871-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty