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General NPI Number Information
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NPI Number | 1932667508
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Entity Type | Individual
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Provider Name | SAMUEL BRADLEY LOYD
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Gender | Male
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Dates
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Enumeration Date | 03/03/2019
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Last Update Date | 03/03/2019
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Provider Practice Location Address
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Address Line | 904 DAWN AVE
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City | EPHRATA
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State | PA
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Zip | 17522-1340
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Country | US
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Telephone | 717-738-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 208 FORGET ME NOT DR
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City | EPHRATA
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State | PA
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Zip | 17522-8444
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Country | US
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Telephone | 717-733-2367
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MSG010763
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License Number State | PA
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