Individual
TAMORA T WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
525 W 42ND ST, NEW YORK, NY 10036-6205
(212) 473-3689
Mailing address
518 W 204TH ST APT 53, NEW YORK, NY 10034-4009
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
026562-02
NY
Other
Enumeration date
02/21/2024
Last updated
02/21/2024
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