Individual
MR. MICHAEL CLARENCE RUSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5102 TRANSIT RD, DEPEW, NY 14043-4465
(716) 341-5152
Mailing address
78 SOUTHPOINT DR, LANCASTER, NY 14086-3334
(716) 341-5152
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
022275
NY
Other
Enumeration date
03/09/2009
Last updated
03/09/2009
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