MEDICARE: JORDANA R SELTZER CMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1689947475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDANA R SELTZER CMT

Provider Business Mailing Address
First Line	:	315 FORSGATE DR
Second Line	:
City	:	MONROE TOWNSHIP
State	:	NJ
Zip	:	08831-1539
Country	:	US
Telephone Number	:	732-656-7600
Fax Number	:	732-387-8301

Provider Business Practice Location Address
First Line	:	315 FORSGATE DR
Second Line	:
City	:	MONROE TOWNSHIP
State	:	NJ
Zip	:	08831-1539
Country	:	US
Telephone Number	:	732-656-7600
Fax Number	:	732-387-8301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2012
Last Update Date	:	02/12/2012

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