Individual
SAMUEL KENT AXTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2101 ROUTE 9, ROUND LAKE, NY 12151-1711
(518) 669-5462
Mailing address
10 PARTRIDGE GLN, REXFORD, NY 12148-1344
(518) 669-5462
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
029143
NY
Other
Enumeration date
04/04/2020
Last updated
04/04/2020
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