Individual
THOR ERIC KORNELIUSSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2 LINCOLN AVE, HOLBROOK, NY 11741-2248
(631) 405-0333
Mailing address
2 LINCOLN AVE, HOLBROOK, NY 11741-2248
(631) 405-0333
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
030761
NY
Other
Enumeration date
01/28/2018
Last updated
04/05/2019
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