Healthcare Provider Details

I. General information

NPI: 1790387363
Provider Name (Legal Business Name): SIMPLICE NVUT NJOYA LMT. MS. PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 BLISS DR
PITTSBURGH PA
15236-4008
US

IV. Provider business mailing address

413 BLISS DRIVE
PITTSBURGH PA
15236
US

V. Phone/Fax

Practice location:
  • Phone: 724-359-7030
  • Fax:
Mailing address:
  • Phone: 724-359-7030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG007101
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: