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General NPI Number Information
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NPI Number | 1538333299
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Entity Type | Individual
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Provider Name | MAGDALENA ESCOBAR PMM, MT
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Gender | Female
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 7419 SPOUT SPRINGS RD SUITE B-102
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-5515
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Country | US
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Telephone | 770-965-8259
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Fax |
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Provider Business Mailing Address
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Address Line | 24 COUNTRY COVE DR
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City | BRASELTON
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State | GA
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Zip | 30517-2633
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Country | US
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Telephone | 678-943-1475
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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 | MT001463
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License Number State | GA
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