Individual
MARY LAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
520 FRANKLIN AVE STE 215, GARDEN CITY, NY 11530-5815
(516) 987-4826
Mailing address
520 FRANKLIN AVE STE 215, GARDEN CITY, NY 11530-5815
(516) 987-4826
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
019595
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019595
NYS LICENSE MASSAGE THERAPY
NY
Enumeration date
03/09/2022
Last updated
03/09/2022
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