Individual
LISA PIVONKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
500 S CASCADE DR, SPRINGVILLE, NY 14141-9278
(716) 353-2222
Mailing address
500 S CASCADE DR, SPRINGVILLE, NY 14141-9278
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0286721
NY
Other
Enumeration date
09/21/2015
Last updated
07/06/2016
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