Healthcare Provider Details

I. General information

NPI: 1457754723
Provider Name (Legal Business Name): AMANDA VACHARAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 ACADEMY LN
ELKINS PARK PA
19027-2514
US

IV. Provider business mailing address

1413 ACADEMY LN
ELKINS PARK PA
19027-2514
US

V. Phone/Fax

Practice location:
  • Phone: 267-241-7501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG008431
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: