Provider Demographics
NPI:1598512915
Name:PLACIDE, HARRY (LMT)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:PLACIDE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SMITHTOWN BLVD APT 24B
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1763
Mailing Address - Country:US
Mailing Address - Phone:631-764-7812
Mailing Address - Fax:
Practice Address - Street 1:560 MAIN ST STE 2C
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3540
Practice Address - Country:US
Practice Address - Phone:631-867-2843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032890-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty