Individual
MANUEL VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1018 CASTLE HILL AVE, BRONX, NY 10472-6304
(718) 904-8656
(718) 904-8663
Mailing address
564 W 160TH ST APT 55, NEW YORK, NY 10032-6749
(646) 505-8798
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
024615
NY
Other
Enumeration date
01/20/2011
Last updated
01/20/2011
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