Healthcare Provider Details

I. General information

NPI: 1003430927
Provider Name (Legal Business Name): CHRISTINE LIPISKO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 MERIDIAN AVE
SCRANTON PA
18504-2630
US

IV. Provider business mailing address

545 EMMETT ST
SCRANTON PA
18505-1016
US

V. Phone/Fax

Practice location:
  • Phone: 570-207-9114
  • Fax:
Mailing address:
  • Phone: 570-499-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
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: