Healthcare Provider Details

I. General information

NPI: 1205652484
Provider Name (Legal Business Name): CHRISTINA GROW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 HARRISBURG PIKE
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

1929 OREGON PIKE APT J11
LANCASTER PA
17601-6458
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG016007
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: