Individual
MELISSA BLOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
19 CHARLES AVE, HOLBROOK, NY 11741
(516) 779-2309
Mailing address
19 CHARLES AVE, HOLBROOK, NY 11741-3301
(516) 779-2309
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
027056
NY
Other
Enumeration date
06/27/2017
Last updated
07/21/2022
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