Provider Demographics
NPI:1225398050
Name:BUCKS LYMPHEDEMA MASSAGE BY STACY BLAINE
Entity Type:Organization
Organization Name:BUCKS LYMPHEDEMA MASSAGE BY STACY BLAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-491-1150
Mailing Address - Street 1:2372 GREENSWARD S
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2040
Mailing Address - Country:US
Mailing Address - Phone:215-491-1150
Mailing Address - Fax:215-491-1150
Practice Address - Street 1:2372 GREENSWARD S
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2040
Practice Address - Country:US
Practice Address - Phone:215-491-1150
Practice Address - Fax:215-491-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-27
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018677261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy