Healthcare Provider Details

I. General information

NPI: 1326387150
Provider Name (Legal Business Name): CHERYL HURLEY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 ROUTE 18 SUITE 205
EAST BRUNSWICK NJ
08816-3727
US

IV. Provider business mailing address

19 FORD AVE APT C
MILLTOWN NJ
08850-1573
US

V. Phone/Fax

Practice location:
  • Phone: 732-853-3471
  • Fax:
Mailing address:
  • Phone: 732-853-3471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT00170200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: