Healthcare Provider Details

I. General information

NPI: 1861153587
Provider Name (Legal Business Name): SAMANTHA J BRUNTRAGER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 01/05/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 HARRISBURG PIKE STE 315
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

4553 KLINESVILLE RD
COLUMBIA PA
17512-8427
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3555
  • Fax:
Mailing address:
  • Phone: 717-327-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG013994
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: