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General NPI Number Information
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NPI Number | 1770718249
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Entity Type | Organization
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Legal Business Name | WORKING WITH PRIDE
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Dates
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Enumeration Date | 05/27/2009
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | 722 S ITHAN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19143-2810
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Country | US
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Telephone | 215-747-4361
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Fax |
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Provider Business Mailing Address
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Address Line | 722 S ITHAN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19143-2810
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Country | US
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Telephone | 215-747-4361
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | SHERRI FRENCHANATTA COSTON
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Credential |
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Telephone | 215-747-4361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 458095
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License Number State | PA
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