Individual
MR. JASON P KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
709 N MAIN ST, NORTH SYRACUSE, NY 13212-1669
(315) 459-4549
Mailing address
709 N MAIN ST, NORTH SYRACUSE, NY 13212-1669
(315) 459-4549
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
021332-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9286674
VA PROGRAM
NY
Enumeration date
02/08/2019
Last updated
02/08/2019
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