Provider Demographics
NPI:1447359211
Name:MERRITT, GARY R (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:R
Last Name:MERRITT
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 GOODMAN ST N
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1501
Mailing Address - Country:US
Mailing Address - Phone:585-721-1027
Mailing Address - Fax:585-420-9138
Practice Address - Street 1:39 GOODMAN ST N
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1501
Practice Address - Country:US
Practice Address - Phone:585-721-1027
Practice Address - Fax:585-420-9138
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011528225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY175871GGOtherPREFERRED CARE - MASSAGE