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General NPI Number Information
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NPI Number | 1780918961
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Entity Type | Organization
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Legal Business Name | MEDICAL MASSAGE OF DELAWARE
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 105 MEGAN DR
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City | BEAR
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State | DE
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Zip | 19701-2085
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Country | US
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Telephone | 888-757-1951
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 240
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City | KIRKWOOD
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State | DE
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Zip | 19708-0240
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Country | US
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Telephone | 888-757-1951
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Fax |
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Authorized Official
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Title or Position | LMT
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Name | JACKIE STAKER
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Credential |
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Telephone | 888-757-1951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MT0001873
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License Number State | DE
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