Healthcare Provider Details

I. General information

NPI: 1760812036
Provider Name (Legal Business Name): LINSEY CICCOCIOPPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 PARADISE LN
NEW BLOOMFIELD PA
17068-8002
US

IV. Provider business mailing address

184 PARADISE LN
NEW BLOOMFIELD PA
17068-8002
US

V. Phone/Fax

Practice location:
  • Phone: 717-834-7059
  • Fax:
Mailing address:
  • Phone: 717-835-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005459
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG007522
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: