=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871877001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIALTOUCH MASSAGES,LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2011
-----------------------------------------------------
Last Update Date | 10/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42 S 15TH ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-2218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-909-0316
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3120 MEMPHIS ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19134-4426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-909-0316
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CMT/CEO
-----------------------------------------------------
Name | CECELIA REX
-----------------------------------------------------
Credential | CMT
-----------------------------------------------------
Telephone | 18889090316
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | RR00323
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------