=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891147112
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANZ RUDOLF PECKA LMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2016
-----------------------------------------------------
Last Update Date | 07/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1301 ALLEGHENY ST SUITE 101
-----------------------------------------------------
City | HOLLIDAYSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16648-2455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-207-5294
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1662 SAINT FRANCIS LN
-----------------------------------------------------
City | ALTOONA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16602-7322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-207-5294
-----------------------------------------------------
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 | MSG009141
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------