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General NPI Number Information
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NPI Number | 1538605118
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Entity Type | Organization
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Legal Business Name | PENN ACUPUNCTURE PARTNERS
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Dates
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Enumeration Date | 01/06/2017
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Last Update Date | 01/06/2017
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Provider Practice Location Address
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Address Line | 1500 MARKET ST 12TH FLOOR EAST TOWER
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City | PHILADELPHIA
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State | PA
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Zip | 19102-2100
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Country | US
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Telephone | 215-220-3842
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Fax |
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Provider Business Mailing Address
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Address Line | 10065 SANDMEYER LN STE 301
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City | PHILADELPHIA
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State | PA
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Zip | 19116-3515
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Country | US
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Telephone | 215-220-3842
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | OLGA SELCOVA
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Credential | LAC
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Telephone | 215-220-3842
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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 | AK001022
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License Number State | PA
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