Organization
MOUNTAINSIDE DIVERSIFIED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER MILLER LMT, BCTMB (PARTNER/MANAGER)
(877) 480-8038
Entity
Organization
Contact information
Practice address
1324 FOREST AVE, STATEN ISLAND, NY 10302-2044
(877) 480-8038
Mailing address
PO BOX 20521, STATEN ISLAND, NY 10302-0521
(877) 480-8038
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
03/25/2021
Last updated
03/25/2021
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