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General NPI Number Information
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NPI Number | 1669271193
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Entity Type | Individual
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Provider Name | TINA MARIE NEWCOMB LMT
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Gender |
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Dates
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Enumeration Date | 03/08/2025
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 25 STEVENS AVE STE B1
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City | WEST LAWN
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State | PA
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Zip | 19609-1425
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Country | US
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Telephone | 484-929-0455
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 DENNIS DR
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City | READING
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State | PA
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Zip | 19601-1136
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Country | US
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Telephone | 484-929-0455
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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 | MSG012160
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License Number State | PA
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