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General NPI Number Information
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NPI Number | 1144003336
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Entity Type | Organization
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Legal Business Name | E CLAIRE WELLNESS
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 212 S UNIVERSITY AVE
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City | CARBONDALE
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State | IL
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Zip | 62901-2925
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Country | US
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Telephone | 618-713-1249
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Fax |
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Provider Business Mailing Address
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Address Line | 212 S UNIVERSITY AVE
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City | CARBONDALE
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State | IL
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Zip | 62901-2925
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Country | US
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Telephone | 618-319-0672
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH STRUSZ
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Credential | LMT
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Telephone | 618-203-4624
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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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