Provider Demographics
NPI:1578053476
Name:EAST SHORE THERAPEUTIC MASSAGE CENTER LLC
Entity Type:Organization
Organization Name:EAST SHORE THERAPEUTIC MASSAGE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELLALOGGIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-558-8228
Mailing Address - Street 1:7979 PAXTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-5428
Mailing Address - Country:US
Mailing Address - Phone:813-558-8228
Mailing Address - Fax:
Practice Address - Street 1:7979 PAXTON ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-5428
Practice Address - Country:US
Practice Address - Phone:813-558-8228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty