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General NPI Number Information
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NPI Number | 1073336178
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Entity Type | Organization
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Legal Business Name | PURE ROSE BODYWORK, LLC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 392 W APPLE ST STE 3
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City | RINGTOWN
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State | PA
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Zip | 17967-9448
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Country | US
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Telephone | 570-212-9191
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Fax |
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Provider Business Mailing Address
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Address Line | 393 LOCUST LN
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City | CATAWISSA
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State | PA
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Zip | 17820-8246
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Country | US
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Telephone | 570-212-9191
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST/ OWNER
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Name | JESSICA DAVIS
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Credential | LMT
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Telephone | 570-212-9191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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