Individual
GAVIN LANCE POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASSAGE THERAPIST
Contact information
Practice address
630 W 173RD ST, NEW YORK, NY 10032-1413
(810) 835-9314
Mailing address
PO BOX 250435, NEW YORK, NY 10025-1524
(810) 835-9314
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT014426
GA
Other
Enumeration date
03/21/2023
Last updated
03/21/2023
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