Individual
KIM SU ANN DERMODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2 SOUND RD, D, WADING RIVER, NY 11792-1033
(631) 886-1999
Mailing address
2 SOUND RD, D, WADING RIVER, NY 11792-1033
(631) 886-1999
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
011574
NY
Other
Enumeration date
10/07/2008
Last updated
10/07/2008
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