Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MSG013031 | PA |
NPI | 1003421462 |
---|---|
Provider Name | Mr. Littleton Thomas Szelagowski JR. |
First Address | Eagleville, PA 19403-1413 |
Second Address | Eagleville, PA 19403-1413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2020 |
Last Update Date | 12/09/2020 |