Provider Demographics
NPI:1962281915
Name:SPORTS & MEDICAL MASSAGE LLC
Entity type:Organization
Organization Name:SPORTS & MEDICAL MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMT
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:COLON-GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:484-752-0819
Mailing Address - Street 1:300 W LANCASTER AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-9941
Mailing Address - Country:US
Mailing Address - Phone:484-752-0819
Mailing Address - Fax:
Practice Address - Street 1:300 W LANCASTER AVE FL 1
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-9941
Practice Address - Country:US
Practice Address - Phone:484-752-0819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-27
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty