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General NPI Number Information
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NPI Number | 1215828009
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Entity Type | Organization
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Legal Business Name | THE FASCIA CLINIC LLC
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 1985 ROUTE 34 STE A10
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City | WALL TOWNSHIP
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State | NJ
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Zip | 07719-9164
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Country | US
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Telephone | 732-592-9212
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Fax |
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Provider Business Mailing Address
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Address Line | 178 DUTCH LANE RD
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City | FREEHOLD
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State | NJ
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Zip | 07728-7734
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER NATOLI
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Credential | LMT
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Telephone | 732-670-6379
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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 |
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License Number State |
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