Healthcare Provider Details

I. General information

NPI: 1497667075
Provider Name (Legal Business Name): LARRY HICE JR. LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N 6TH AVE
READING PA
19611-1297
US

IV. Provider business mailing address

2605 WARREN RD
READING PA
19604-1021
US

V. Phone/Fax

Practice location:
  • Phone: 610-750-2523
  • Fax:
Mailing address:
  • Phone: 610-550-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG017086
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: