=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790503399
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANELLE NICOLE CALDERON LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2024
-----------------------------------------------------
Last Update Date | 10/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19B BOULDER HILLS BLVD APT 102
-----------------------------------------------------
City | WANTAGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07461-5497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-995-7078
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19B BOULDER HILLS BLVD APT 102
-----------------------------------------------------
City | WANTAGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07461-5497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-995-7078
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MSG015502
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT109298
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 18KT00866200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------