Healthcare Provider Details

I. General information

NPI: 1780500090
Provider Name (Legal Business Name): GEORGE LEGG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3244 BAILEY ST NW
MASSILLON OH
44646-3616
US

IV. Provider business mailing address

3244 BAILEY ST NW
MASSILLON OH
44646-3616
US

V. Phone/Fax

Practice location:
  • Phone: 330-477-3036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.027635
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: