Provider Demographics
NPI:1679176705
Name:GARDEN, MARJORIE ELLEN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ELLEN
Last Name:GARDEN
Suffix:
Gender:F
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 1:14 SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-3454
Mailing Address - Country:US
Mailing Address - Phone:518-631-9208
Mailing Address - Fax:
Practice Address - Street 1:14 SARATOGA RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-3454
Practice Address - Country:US
Practice Address - Phone:518-631-9208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025358225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist