Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MSG008538 | PA |
NPI | 1013448976 |
---|---|
Provider Name | Elizabeth Telega |
First Address | Aliquippa, PA 15001-5129 |
Second Address | Aliquippa, PA 15001-5129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2017 |
Last Update Date | 22/03/2017 |