Healthcare Provider Details

I. General information

NPI: 1841580040
Provider Name (Legal Business Name): KATHLEEN VROMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2011
Last Update Date: 04/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 BROADWAY
TROY NY
12180-3331
US

IV. Provider business mailing address

10 MAPLE AVE
TROY NY
12180-7133
US

V. Phone/Fax

Practice location:
  • Phone: 518-272-3636
  • Fax:
Mailing address:
  • Phone: 518-867-9346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number27-023555
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: