Provider Demographics
NPI:1093083859
Name:PORAMBO, NANCY M (LMT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:PORAMBO
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 1:616 CENTER ST
Mailing Address - Street 2:PO BOX 494
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-2116
Mailing Address - Country:US
Mailing Address - Phone:610-393-9477
Mailing Address - Fax:570-325-9477
Practice Address - Street 1:616 CENTER STREET
Practice Address - Street 2:
Practice Address - City:JIM THORPE
Practice Address - State:PA
Practice Address - Zip Code:18229
Practice Address - Country:US
Practice Address - Phone:570-325-9477
Practice Address - Fax:570-325-9477
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG000001225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist