Provider Demographics
NPI:1447985387
Name:FUNCTIONAL MASSAGE & PERFORMANCE
Entity type:Organization
Organization Name:FUNCTIONAL MASSAGE & PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:516-355-1792
Mailing Address - Street 1:1054 LITTLE EAST NECK RD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-2413
Mailing Address - Country:US
Mailing Address - Phone:516-355-1792
Mailing Address - Fax:
Practice Address - Street 1:1054 LITTLE EAST NECK RD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-2413
Practice Address - Country:US
Practice Address - Phone:516-355-1792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty