Healthcare Provider Details

I. General information

NPI: 1336664853
Provider Name (Legal Business Name): MS. EVELYN ZUCKERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2017
Last Update Date: 08/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 RUNNALS RD.
WHITE RIVER JUNCTION VT
05001-0500
US

IV. Provider business mailing address

216 RUNNALS RD
WHITE RIVER JUNCTION VT
05001-9234
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-6653
  • Fax: 802-295-6653
Mailing address:
  • Phone: 18022956653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: