Healthcare Provider Details

I. General information

NPI: 1831635077
Provider Name (Legal Business Name): SUZANNA VREELAND LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 BALMORAL CT
ABERDEEN NJ
07747-1854
US

IV. Provider business mailing address

28 BALMORAL CT
ABERDEEN NJ
07747-1854
US

V. Phone/Fax

Practice location:
  • Phone: 646-320-4089
  • Fax:
Mailing address:
  • Phone: 646-320-4089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT01003600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: