Individual
MIMI AZICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
12085 PERRY HWY, WEXFORD, PA 15090-8394
(724) 940-2244
Mailing address
12085 PERRY HWY, WEXFORD, PA 15090-8394
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MSG001617
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0160OK36
ELEMENTS MASSAGE WEXFORD
PA
01
—
0160OK36
ELEMENTS MASSAGE - WEXFORD
—
Enumeration date
10/09/2019
Last updated
10/09/2019
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