Individual
KATHIANA PROPHETE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1933 SPRINGFIELD AVE, MAPLEWOOD, NJ 07040-3416
(908) 838-1693
Mailing address
1167 E JERSEY ST APT 3R, ELIZABETH, NJ 07201-2374
(908) 838-1692
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18KT01186900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
824620009
—
NJ
Enumeration date
06/14/2019
Last updated
06/14/2019
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