Provider Demographics
NPI:1730563347
Name:MUSCLE REHAB MASSAGE THERAPY
Entity type:Organization
Organization Name:MUSCLE REHAB MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:MCKIMMEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:484-891-0568
Mailing Address - Street 1:6801 TILGHMAN ST
Mailing Address - Street 2:UNIT #103
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9593
Mailing Address - Country:US
Mailing Address - Phone:484-891-0568
Mailing Address - Fax:610-601-4413
Practice Address - Street 1:6801 TILGHMAN ST
Practice Address - Street 2:UNIT #103
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9593
Practice Address - Country:US
Practice Address - Phone:484-891-0568
Practice Address - Fax:610-601-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty