1750516084 NPI number — WAI PAIN MANAGEMENT MASSAGE THERAPY

Table of content: (NPI 1750516084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750516084 NPI number — WAI PAIN MANAGEMENT MASSAGE THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAI PAIN MANAGEMENT MASSAGE THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750516084
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1231 CHESTNUT ST # 128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-4105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-255-4039
Provider Business Mailing Address Fax Number:
215-829-0499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
934 ARCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-3107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-255-4039
Provider Business Practice Location Address Fax Number:
215-829-0499
Provider Enumeration Date:
05/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
AU
Authorized Official First Name:
WAI
Authorized Official Middle Name:
MUN
Authorized Official Title or Position:
MASSAGE THERAPIT
Authorized Official Telephone Number:
267-255-4039

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  207881 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1750516084 . This is a "KEYSTONE HEALTH PLEN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1750516084 . This is a "KEYSTONE MARCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1750516084 . This is a "MOUNTAIN STATE BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1750516084 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1750516084 . This is a "UNIFORM MEDICAL PLAN- HARRINGTON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1750516084 . This is a "INDEPENDENCE BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1750516084 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1750516084 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1750516084 . This is a "HIGHMARK BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1750516084 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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