Jessica Licata, MASSAGE THERAPIST

NPI #1619673787 in Middle Island, New York

Provider Information

NPI Number: 1619673787
Entity Type: Individual
Name: Jessica Licata, MASSAGE THERAPIST
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Massage Therapist
Credential: MASSAGE THERAPIST
Enumeration Date: Feb 1, 2023
Last Updated: Feb 1, 2023

Practice Location

Address: 1225 MIDDLE COUNTRY RD
City: Middle Island
State: New York
ZIP Code: 11953-2515
Phone: (631) 637-6000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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