Healthcare Provider Details

I. General information

NPI: 1649968439
Provider Name (Legal Business Name): BRIDGET SCOBEE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 30TH ST NE
CANTON OH
44714-1404
US

IV. Provider business mailing address

1206 E MARKET ST
WARREN OH
44483
US

V. Phone/Fax

Practice location:
  • Phone: 330-491-0381
  • Fax: 330-491-0388
Mailing address:
  • Phone: 330-394-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.025731
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: