Jonathan Michael Wilson
Massage Therapist in East Setauket, NY. Individual provider (NPI-1).
NPI number1144836610
StatusActive
Last updated in NPPESSep 21, 2020
Details
- NPI
- 1144836610
- Entity type
- Individual (NPI-1)
- Name
- Jonathan Michael Wilson
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 21, 2020
- Certification date
- Sep 15, 2020
- Last updated
- Sep 21, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225700000X | Massage Therapist | 027140-1 | NY | Yes |
Practice location
1386 Route 25aEast Setauket, NY 11733-2842
Phone 631-751-2375
Mailing address
1386 Route 25aEast Setauket, NY 11733-2842
Phone 631-751-2374
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All 30 Massage Therapist providers in East Setauket · All 1,130 providers in East Setauket
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