Healthcare Provider Details

I. General information

NPI: 1558855007
Provider Name (Legal Business Name): NIKOLAS LEE DALESSANDRO LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 FTFTH ST
WEST ELIZABETH PA
15088
US

IV. Provider business mailing address

1604 MARION DR
FINLEYVILLE PA
15332-1540
US

V. Phone/Fax

Practice location:
  • Phone: 412-888-7752
  • Fax:
Mailing address:
  • Phone: 412-889-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG012372
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: