Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MSG000610 | PA |
NPI | 1003277955 |
---|---|
Provider Name | Megan Eargle |
First Address | State College, PA 16801-4672 |
Second Address | State College, PA 16801-4672 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2016 |
Last Update Date | 18/03/2016 |