Individual
MISS ANDY JULISSA GARCIA SOTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
115 BROADHOLLOW RD STE 10, MELVILLE, NY 11747-4992
(631) 990-4352
Mailing address
16 N JONES RD, HAMPTON BAYS, NY 11946-3508
(631) 494-0466
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
114427-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
79507690000
OXFORD LIBERTY
—
Enumeration date
04/06/2022
Last updated
04/06/2022
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