Individual
MARY AMANDA PETACCHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
257 DELAWARE AVE STE 2, DELMAR, NY 12054-1135
(845) 633-3866
Mailing address
257 DELAWARE AVE STE 2, DELMAR, NY 12054-1135
(845) 633-3866
Taxonomy
Speciality
Code
Description
License number
State
173C00000X
Reflexologist
031147
NY
225000000X
Orthotic Fitter
031147
NY
225700000X
Massage Therapist
Primary
031147
NY
Other
Enumeration date
02/25/2021
Last updated
02/25/2021
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