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General NPI Number Information
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NPI Number | 1184232233
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Entity Type | Individual
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Provider Name | STETSON PAUL MACIAS LMT
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Gender | Male
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Dates
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Enumeration Date | 07/15/2020
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 225 S HENDERSON RD
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2416
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Country | US
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Telephone | 610-354-0138
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 PENN CIR APT F614
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-1033
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Country | US
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Telephone | 425-243-9190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MSG012789
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License Number State | PA
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