Organization
WORKING WITH PRIDE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRI FRENCHANATTA COSTON (MASSAGE THERAPIST)
(215) 747-4361
Entity
Organization
Contact information
Practice address
722 S ITHAN ST, PHILADELPHIA, PA 19143-2810
(215) 747-4361
Mailing address
722 S ITHAN ST, PHILADELPHIA, PA 19143-2810
(215) 747-4361
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
458095
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
613742300
DOL FECA
PA
Enumeration date
05/27/2009
Last updated
06/29/2009
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