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General NPI Number Information
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NPI Number | 1477046563
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Entity Type | Individual
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Provider Name | JEANETTE RENEE LUNDELL
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Gender | Female
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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 | 135 CUMBERLAND RD STE 106
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City | PITTSBURGH
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State | PA
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Zip | 15237-5447
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Country | US
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Telephone | 412-445-6769
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Fax |
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Provider Business Mailing Address
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Address Line | 135 CUMBERLAND RD STE 106
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City | PITTSBURGH
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State | PA
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Zip | 15237-5447
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Country | US
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Telephone | 412-445-6769
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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 | MSG010470
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License Number State | PA
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