Provider Demographics
NPI:1033686134
Name:WAUGH, EMILY MEGAN
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MEGAN
Last Name:WAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 N 27TH ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-4605
Mailing Address - Country:US
Mailing Address - Phone:267-600-1081
Mailing Address - Fax:
Practice Address - Street 1:1740 SOUTH ST STE 503
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1572
Practice Address - Country:US
Practice Address - Phone:215-430-3309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG012263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist