Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | PA |
NPI | 1003430927 |
---|---|
Provider Name | Christine Lipisko |
First Address | Scranton, PA 18505-1016 |
Second Address | Scranton, PA 18504-2630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2020 |
Last Update Date | 05/06/2020 |