Individual
MICHAEL DESOIZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1787 MIDDLE COUNTRY RD, CENTEREACH, NY 11720-3507
(631) 767-9337
Mailing address
360 STATION RD, BELLPORT, NY 11713-2117
(631) 767-9337
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
028288-1
NY
Other
Enumeration date
11/05/2018
Last updated
11/05/2018
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