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General NPI Number Information
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NPI Number | 1669968194
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Entity Type | Individual
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Provider Name | PRATHIBHA KULAKKUZHIYIL BALAN
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Gender | Female
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Dates
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Enumeration Date | 07/09/2018
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Last Update Date | 07/09/2018
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Provider Practice Location Address
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Address Line | 1503 FINNEGAN LN
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902-1061
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Country | US
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Telephone | 732-658-6070
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Fax | 888-828-3316
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Provider Business Mailing Address
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Address Line | 22N READING RD
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City | EDISON
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State | NJ
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Zip | 08817-2184
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Country | US
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Telephone | 952-495-4196
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Fax |
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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 | 18KT01280800
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License Number State | NJ
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