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General NPI Number Information
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NPI Number | 1730563347
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Entity Type | Organization
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Legal Business Name | MUSCLE REHAB MASSAGE THERAPY
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 11/28/2015
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Provider Practice Location Address
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Address Line | 6801 TILGHMAN ST UNIT #103
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City | ALLENTOWN
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State | PA
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Zip | 18106-9593
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Country | US
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Telephone | 484-891-0568
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Fax | 610-601-4413
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Provider Business Mailing Address
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Address Line | 6801 TILGHMAN ST UNIT #103
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City | ALLENTOWN
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State | PA
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Zip | 18106-9593
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Country | US
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Telephone | 484-891-0568
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Fax | 610-601-4413
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Authorized Official
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Title or Position | LICENSED MASSAGE THERAPIST
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Name | MRS. ADRIENNE MICHELE MCKIMMEY
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Credential | LMT
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Telephone | 484-891-0568
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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 | MSG003217
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License Number State | PA
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