Individual
ALISSA DANDRILLI LATERZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
34 OCEAN AVE, ISLIP, NY 11751-3804
(631) 871-7938
Mailing address
34 OCEAN AVE, ISLIP, NY 11751-3804
(631) 871-7938
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
021091-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0273137506-8
HEALTHCARE PROVIDERS SERVICE ORGANIZATION
NY
Enumeration date
06/26/2007
Last updated
12/30/2020
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