Most Relevant Information
Provider Data
| NPI Number: | 1003391665 |
| Provider Name: | MARIA JEAN MIRISSIS MASSAGE THERAPIST |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | 006241 |
Most Important Dates
| Enumeration Date: | 09/30/2018 |
| Last Updated: | 09/30/2018 |
Provider Practice Location
10 FORT SALONGA RD STE 2A
NORTHPORT
NY
117681465
Practice Location Phone/Fax
| Phone: | 6313439194 |
| Fax: |
Provider Mailing Location
10 FORT SALONGA RD STE 2A
NORTHPORT
NY
117681465
Provider Mailing Phone/Fax
| Phone: | 6313439194 |
| Fax: |