Individual
LINDA ELLEN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
120 WOODBINE AVE, NORTHPORT, NY 11768-2897
(516) 353-8891
Mailing address
104 HUNTING CT, ELWOOD, NY 11731-4835
(516) 353-8891
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
012131
NY
Other
Enumeration date
01/26/2023
Last updated
01/26/2023
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