Individual
LISA BALLONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1041 ROUTE 112, PORT JEFFERSON STATION, NY 11776-6000
(631) 828-4545
Mailing address
66 RIALTO WAY, PATCHOGUE, NY 11772-3566
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
015698-1
NY
Other
Enumeration date
05/10/2019
Last updated
05/10/2019
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