Provider Demographics
NPI:1770718249
Name:WORKING WITH PRIDE
Entity type:Organization
Organization Name:WORKING WITH PRIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:FRENCHANATTA
Authorized Official - Last Name:COSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-747-4361
Mailing Address - Street 1:722 S ITHAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-2810
Mailing Address - Country:US
Mailing Address - Phone:215-747-4361
Mailing Address - Fax:
Practice Address - Street 1:722 S ITHAN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-2810
Practice Address - Country:US
Practice Address - Phone:215-747-4361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA458095172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA613742300OtherDOL FECA