Avery Sofia Wagner, LMT
Individual provider Active NPI Massage Therapist · Campbelltown, PA
NPI 1346054483 · NPPES record last updated Mar 10, 2025
Key facts
- NPI
- 1346054483
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MSG016108 (PA)
- Practice address
- PO Box 494
Campbelltown, PA 17010-0494 - Phone
- (717) 838-2600
- NPI assigned
- Feb 6, 2025
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MSG016108 | PA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Green Wellness Massage LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MSG016108 | PA | Yes |
Addresses
Primary practice location
PO Box 494
Campbelltown, PA 17010-0494
Mailing address
PO Box 494
Campbelltown, PA 17010-0494
Phone (717) 740-0080
Other providers in Campbelltown, PA
- Green Wellness Massage LLC
- Marthom Corporation
- Reliant Twin Oaks Holdings, LLC
- Elizabeth Southam
- David G Thompson
- Rylei Hayes Zimmerman
All providers in Campbelltown, PA · Massage Therapist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.