Individual
MR. TIMOTHY MICHAEL ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT.
Contact information
Practice address
544 MAIN ST APT 4, BEACON, NY 12508-2861
(631) 456-3659
Mailing address
544 MAIN ST APT 4, BEACON, NY 12508-2861
(631) 456-3659
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
025347
NY
Other
Enumeration date
06/12/2019
Last updated
06/12/2019
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