Individual
PETR LISSOVSKIY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
50 COLUMBUS AVE APT F21, TUCKAHOE, NY 10707-2545
(914) 573-9211
Mailing address
50 COLUMBUS AVE APT F21, TUCKAHOE, NY 10707-2545
(914) 573-9211
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
031264
NY
Other
Enumeration date
09/01/2020
Last updated
09/01/2020
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