Provider Demographics
NPI:1962219386
Name:BLESSED BRIDAL AND BODY
Entity type:Organization
Organization Name:BLESSED BRIDAL AND BODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LMT
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:MEREDITH POTTER
Authorized Official - Last Name:SUK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:607-279-2888
Mailing Address - Street 1:463 CASWELL RD
Mailing Address - Street 2:
Mailing Address - City:FREEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13068-9723
Mailing Address - Country:US
Mailing Address - Phone:607-279-2888
Mailing Address - Fax:
Practice Address - Street 1:4 MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2608
Practice Address - Country:US
Practice Address - Phone:607-279-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty