Healthcare Provider Details

I. General information

NPI: 1255147864
Provider Name (Legal Business Name): BRIE-ANNE BECKER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIE-ANNE KULP

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/11/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 HARRISBURG PIKE SUITE 315
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2108 HARRISBURG PIKE SUITE 315
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3555
  • Fax: 717-544-3560
Mailing address:
  • Phone: 717-544-3555
  • Fax: 717-544-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG012153
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: