Individual
JONATHAN CARTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
54 WAVE CREST DR, ISLIP, NY 11751-4016
(516) 240-5127
Mailing address
54 WAVE CREST DR, ISLIP, NY 11751-4016
(516) 240-5127
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
026655
NY
Other
Enumeration date
10/15/2014
Last updated
10/15/2014
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