=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770476723
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA VANVYNCK LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2025
-----------------------------------------------------
Last Update Date | 05/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 BROAD ST
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18337-1532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-618-1879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1710 LAURAL ST
-----------------------------------------------------
City | STROUDSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18360-1260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-618-1879
-----------------------------------------------------
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 | MSG013281
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------