Individual
RUSSELL JAMES BASILIERE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
109 S WARREN ST STE 301, SYRACUSE, NY 13202-1798
(315) 937-5953
Mailing address
7543 ELMCREST RD, LIVERPOOL, NY 13090-2846
(315) 679-1954
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
030876-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030876-01
MASSAGE THERAPY
NY
Enumeration date
08/31/2022
Last updated
08/31/2022
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