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General NPI Number Information
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NPI Number | 1174043178
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Entity Type | Individual
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Provider Name | MICHELLE SMITH LMT
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 436 ROUTE 79, SUITE 21
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City | MORGANVILLE
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State | NJ
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Zip | 07751
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Country | US
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Telephone | 732-617-8000
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Fax | 732-591-1000
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Provider Business Mailing Address
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Address Line | 436 ROUTE 79 STE 21
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City | MORGANVILLE
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State | NJ
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Zip | 07751-9783
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Country | US
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Telephone | 732-617-8000
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Fax | 732-591-1000
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 18KT00788800
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License Number State | NJ
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