Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MSG011593 | PA |
NPI | 1003325127 |
---|---|
Provider Name | Jeremy Allan Lowery |
First Address | Connellsville, PA 15425-3842 |
Second Address | Greensburg, PA 15601-5630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2017 |
Last Update Date | 20/09/2017 |