Provider Demographics
NPI:1740660075
Name:KELLNER-TSULIS, SARA (LMT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KELLNER-TSULIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PAYSON AVE
Mailing Address - Street 2:APT 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2716
Mailing Address - Country:US
Mailing Address - Phone:646-203-9211
Mailing Address - Fax:
Practice Address - Street 1:55 PAYSON AVE
Practice Address - Street 2:APT 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-2716
Practice Address - Country:US
Practice Address - Phone:646-203-9211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27022306225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist