Individual provider · NPI-1

Russell James Basiliere, LMT

Massage Therapist · Syracuse, NY

NPI number1427778380
StatusActive
Last updated in NPPESAug 31, 2022

Details

NPI
1427778380
Entity type
Individual (NPI-1)
Name
Russell James Basiliere
Credential
LMT
Sex
Male
Sole proprietor
Yes
Enumeration date
Aug 31, 2022
Certification date
Aug 26, 2022
Last updated
Aug 31, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225700000X Massage Therapist030876-01NYYes

Practice location

109 S Warren St Ste 301
Syracuse, NY 13202-1798

Phone 315-937-5953

Mailing address

7543 Elmcrest Rd
Liverpool, NY 13090-2846

Phone 315-679-1954

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