Provider Demographics
NPI:1316583420
Name:UNWIND THERAPEUTIC MASSAGE OF THE POCONOS
Entity type:Organization
Organization Name:UNWIND THERAPEUTIC MASSAGE OF THE POCONOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:610-703-4563
Mailing Address - Street 1:35 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-2816
Mailing Address - Country:US
Mailing Address - Phone:610-703-4563
Mailing Address - Fax:
Practice Address - Street 1:35 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2816
Practice Address - Country:US
Practice Address - Phone:610-703-4563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty