Healthcare Provider Details

I. General information

NPI: 1346104676
Provider Name (Legal Business Name): 1401 COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 GERMANTOWN AVE APT 1K
PHILADELPHIA PA
19122-3758
US

IV. Provider business mailing address

533 E GIRARD AVE
PHILADELPHIA PA
19125-3311
US

V. Phone/Fax

Practice location:
  • Phone: 215-235-6683
  • Fax:
Mailing address:
  • Phone: 215-235-6683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MRS. PIER DERRICKSON
Title or Position: OWNER ACUPUNCTURIST
Credential: LAC
Phone: 215-235-6683