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General NPI Number Information
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NPI Number | 1235622234
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Entity Type | Organization
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Legal Business Name | PRODIGO DAY SPA, LLC
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 439 MAIN ST
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City | HARLEYSVILLE
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State | PA
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Zip | 19438-4321
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Country | US
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Telephone | 215-256-1191
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Fax |
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Provider Business Mailing Address
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Address Line | 439 MAIN ST
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City | HARLEYSVILLE
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State | PA
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Zip | 19438-4321
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Country | US
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Telephone | 215-256-1191
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TARA LIEBERHER
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Credential |
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Telephone | 215-416-8295
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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 | PA
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