Individual
COREY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2605 BREWERTON RD, MATTYDALE, NY 13211-1147
(315) 455-9355
Mailing address
2605 BREWERTON RD, MATTYDALE, NY 13211-1147
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
031617
NY
Other
Enumeration date
07/19/2019
Last updated
07/19/2019
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