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General NPI Number Information
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NPI Number | 1275184129
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Entity Type | Organization
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Legal Business Name | EKG WELLNESS SERVICES LLC
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Dates
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Enumeration Date | 09/23/2019
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Last Update Date | 09/23/2019
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Provider Practice Location Address
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Address Line | 215 ALLEGHENY AVE
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City | OAKMONT
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State | PA
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Zip | 15139-2058
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Country | US
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Telephone | 412-423-5445
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Fax | 724-212-3595
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Provider Business Mailing Address
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Address Line | 113 CLINTON AVE
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City | LOWER BURRELL
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State | PA
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Zip | 15068-2620
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Country | US
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Telephone | 412-996-9128
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Fax | 724-212-3595
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Authorized Official
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Title or Position | CEO
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Name | ELLWOOD CHARLES CROUSE III
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Credential |
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Telephone | 412-996-9128
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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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