Provider Demographics
NPI:1215757380
Name:MASCOLA, BREI (LMT)
Entity type:Individual
Prefix:
First Name:BREI
Middle Name:
Last Name:MASCOLA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26822 LEWES GEORGETOWN HWY UNIT B
Mailing Address - Street 2:
Mailing Address - City:HARBESON
Mailing Address - State:DE
Mailing Address - Zip Code:19951-2856
Mailing Address - Country:US
Mailing Address - Phone:302-827-7447
Mailing Address - Fax:
Practice Address - Street 1:26822 LEWES GEORGETOWN HWY UNIT B
Practice Address - Street 2:
Practice Address - City:HARBESON
Practice Address - State:DE
Practice Address - Zip Code:19951-2856
Practice Address - Country:US
Practice Address - Phone:302-827-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0005076225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist