=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649941295
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. ALONZO JEFFRIES
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2021
-----------------------------------------------------
Last Update Date | 09/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 ABBEYVILLE RD APT E
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15228-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-390-7388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 ABBEYVILLE RD APT E
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15228-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-390-7388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MSG011311
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------