Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MSG007277 | PA |
NPI | 1013396894 |
---|---|
Provider Name | Amber Titus |
First Address | Bellefonte, PA 16823 |
Second Address | Bellefonte, PA 16823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2015 |
Last Update Date | 05/06/2015 |