Individual provider · Type 1 NPI

Nicole Irene Broderick, LMT

Massage Therapist · East Islip, NY

NPI number 1396375747 Active

Practice location

99 E Main St Ste 1
East Islip, NY 11730-2538

Call (631) 647-8324 Map

Fax (631) 352-0051

Specialties and licenses

TaxonomyCodeLicense
Massage Therapist Primary 225700000X016018-1 (NY)

Massage Therapist: An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.

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About NPI 1396375747

Nicole Irene Broderick, LMT's National Provider Identifier is 1396375747, issued on Jan 23, 2020. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in East Islip, NY. The record was last updated on Jan 23, 2020.