Provider Demographics
NPI:1699549618
Name:DINOVO, MICHELE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:DINOVO
Suffix:
Gender:F
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 1:1686 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-4307
Mailing Address - Country:US
Mailing Address - Phone:518-596-0076
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:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031416225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist