Individual
MRS. STACI DIANE IRWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.T
Contact information
Practice address
12650 EDINBORO RD, EDINBORO, PA 16412-6016
(814) 734-4541
(814) 734-5562
Mailing address
12650 EDINBORO RD, EDINBORO, PA 16412-6016
(814) 734-4541
(814) 734-5562
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MSG001363
PA
Other
Enumeration date
11/15/2011
Last updated
11/15/2011
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