Healthcare Provider Details

I. General information

NPI: 1235784331
Provider Name (Legal Business Name): ANDREW LLOYD LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403D GORDON DR
EXTON PA
19341-1249
US

IV. Provider business mailing address

403D GORDON DR
EXTON PA
19341-1249
US

V. Phone/Fax

Practice location:
  • Phone: 484-341-8598
  • Fax:
Mailing address:
  • Phone: 484-341-8598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG012231
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: