Individual
MR. BRIAN DEFREEST KATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
709 N MAIN ST, NORTH SYRACUSE, NY 13212-1669
(315) 937-5954
Mailing address
8309 PROVO DR, LIVERPOOL, NY 13090-4106
(845) 702-5096
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
032423-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032423-01
PRIVATE INSURANCE
NY
Enumeration date
03/21/2022
Last updated
03/21/2022
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