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General NPI Number Information
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NPI Number | 1316526676
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Entity Type | Individual
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Provider Name | JASON MATTHEW WHISTLER LMT
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Gender | Male
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 2346 N SUSQUEHANNA TRL
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City | SELINSGROVE
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State | PA
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Zip | 17870-7776
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Country | US
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Telephone | 570-437-0333
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Fax |
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Provider Business Mailing Address
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Address Line | 19 MICHAEL LN
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City | WATSONTOWN
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State | PA
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Zip | 17777-8070
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Country | US
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Telephone | 570-246-9991
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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 | MSG014030
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License Number State | PA
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