Healthcare Provider Details

I. General information

NPI: 1396200333
Provider Name (Legal Business Name): REBECCA MAGILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 FURNACE HILLS PIKE
LITITZ PA
17543-8907
US

IV. Provider business mailing address

547 CREEKSIDE LN
LITITZ PA
17543-6813
US

V. Phone/Fax

Practice location:
  • Phone: 717-626-6288
  • Fax:
Mailing address:
  • Phone: 610-704-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG007488
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: