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General NPI Number Information
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NPI Number | 1346104676
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Entity Type | Organization
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Legal Business Name | 1401 COLLECTIVE LLC
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Dates
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Enumeration Date | 12/11/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 1401 GERMANTOWN AVE APT 1K
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City | PHILADELPHIA
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State | PA
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Zip | 19122-3758
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Country | US
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Telephone | 215-235-6683
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Fax |
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Provider Business Mailing Address
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Address Line | 533 E GIRARD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3311
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Country | US
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Telephone | 215-235-6683
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Fax |
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Authorized Official
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Title or Position | OWNER ACUPUNCTURIST
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Name | MRS. PIER DERRICKSON
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Credential | LAC
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Telephone | 215-235-6683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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