Individual
JEREMY CHILDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
3045 SOUTHWESTERN BLVD, SUITE 102, ORCHARD PARK, NY 14127-1209
(716) 364-5623
Mailing address
2148 DAVIS RD, WEST FALLS, NY 14170-9600
(716) 364-5623
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
027783
NY
Other
Enumeration date
03/09/2014
Last updated
03/09/2014
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