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General NPI Number Information
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NPI Number | 1053692376
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Entity Type | Organization
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Legal Business Name | AESCULAP THERAPEUTIC & SPORTS MASSAGE, LLC
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 1901 N OLDEN AVENUE EXT SUITE 4
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City | EWING
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State | NJ
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Zip | 08618-2111
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Country | US
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Telephone | 609-771-0476
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 N OLDEN AVENUE EXT SUITE 4
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City | EWING
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State | NJ
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Zip | 08618-2111
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Country | US
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Telephone | 609-771-0476
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Fax |
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Authorized Official
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Title or Position | THERAPEUTIC MASSAGE PRACTITIONER
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Name | URSULA SCHMIDT-JORDAN
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Credential | LBMT
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Telephone | 609-771-0476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 18KT00416500
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License Number State | NJ
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