Healthcare Provider Details

I. General information

NPI: 1477809457
Provider Name (Legal Business Name): HOPE WITHIN WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S CHURCH ST SUITE 115
HAZLETON PA
18201-7605
US

IV. Provider business mailing address

305 S CHURCH ST SUITE 115
HAZLETON PA
18201-7605
US

V. Phone/Fax

Practice location:
  • Phone: 570-497-4766
  • Fax: 570-245-3899
Mailing address:
  • Phone: 570-497-4766
  • Fax: 570-245-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG003571
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG003195
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC005879L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MRS. LEA R.M THIBEAULT
Title or Position: CO- OWNER
Credential: LMT
Phone: 570-497-4766