Individual
MR. MATTHEW SIRVENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
96 VILLAGE CIR APT 1, ITHACA, NY 14850-8578
(607) 220-4926
Mailing address
96 VILLAGE CIR APT 1, ITHACA, NY 14850-8578
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
029815-1
NY
Other
Enumeration date
06/19/2022
Last updated
06/19/2022
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