Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MSG012258 | PA |
NPI | 1003381575 |
---|---|
Provider Name | Nicole Hershey |
First Address | Lancaster, PA 17601-2644 |
Second Address | Lancaster, PA 17601-2644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2018 |
Last Update Date | 10/10/2018 |