Provider Demographics
NPI:1518261213
Name:PREZIOSA, KATHLEEN MARY (LMT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:PREZIOSA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:56 MURDOCK RD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-4220
Mailing Address - Country:US
Mailing Address - Phone:516-808-4930
Mailing Address - Fax:
Practice Address - Street 1:100 N CENTRE AVE
Practice Address - Street 2:SUITE202
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3937
Practice Address - Country:US
Practice Address - Phone:516-763-2600
Practice Address - Fax:516-763-4218
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024529-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist