Individual
TYLER PORTELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
700 UNION PKWY, RONKONKOMA, NY 11779-7427
(516) 330-9817
Mailing address
PO BOX 997, BETHPAGE, NY 11714-0019
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
029677
NY
Other
Enumeration date
05/07/2021
Last updated
05/07/2021
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