Provider Demographics
NPI:1194141135
Name:KNEAD TO HEAL THERAPEUTIC MASSAGE
Entity type:Organization
Organization Name:KNEAD TO HEAL THERAPEUTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:SIMONETTI
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:631-828-5337
Mailing Address - Street 1:8 CAYLA LN
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-4257
Mailing Address - Country:US
Mailing Address - Phone:631-828-5337
Mailing Address - Fax:
Practice Address - Street 1:8 CAYLA LN
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-4257
Practice Address - Country:US
Practice Address - Phone:631-828-5337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013171-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty