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General NPI Number Information
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NPI Number | 1700205168
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Entity Type | Individual
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Provider Name | MELORA M MCNUTT LMT
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Gender | Female
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 373 MCMANIGLE RD
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City | BROOKVILLE
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State | PA
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Zip | 15825-5533
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Country | US
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Telephone | 814-849-2620
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Fax | 814-849-2620
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Provider Business Mailing Address
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Address Line | 373 MCMANIGLE RD
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City | BROOKVILLE
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State | PA
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Zip | 15825-5533
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Country | US
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Telephone | 814-849-2620
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Fax | 814-849-2620
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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 | MSG004588
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License Number State | PA
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