Individual
MS. MARY ANNE WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, LMT
Contact information
Practice address
3187 RT 28, SHOKAN, NY 12481-0052
(845) 657-7397
Mailing address
PO BOX 52, SHOKAN, NY 12481-0052
(845) 657-7397
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
009778-1
NY
Other
Enumeration date
08/18/2009
Last updated
08/18/2009
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