Individual
PHILLIP WACKERFUSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
5225 SHERIDAN DR, WILLIAMSVILLE, NY 14221-3573
(716) 626-4466
Mailing address
86 LIVINGSTON ST, BUFFALO, NY 14213-1653
(847) 722-7014
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
028894-1
NY
Other
Enumeration date
08/14/2015
Last updated
08/14/2015
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