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General NPI Number Information
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NPI Number | 1386143543
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Entity Type | Organization
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Legal Business Name | SERIOUSLY SHIATSU AND MASSAGE LLC
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 02/02/2018
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Provider Practice Location Address
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Address Line | 125 WESTRIDGE PL S
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City | PHOENIXVILLE
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State | PA
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Zip | 19460-3377
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Country | US
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Telephone | 203-312-3119
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Fax |
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Provider Business Mailing Address
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Address Line | 125 WESTRIDGE PL S
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City | PHOENIXVILLE
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State | PA
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Zip | 19460-3377
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Country | US
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Telephone | 203-312-3119
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Fax |
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | PHILLIP M HESSE
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Credential |
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Telephone | 203-312-3119
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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 | MSG011814
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License Number State | PA
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