Individual
MRS. JEAN BOUCHER HARTZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
415 E MAIN ST, PORT JEFFERSON, NY 11777-1868
(631) 642-1109
(631) 642-1080
Mailing address
415 E MAIN ST, PORT JEFFERSON, NY 11777-1868
(631) 642-1109
(631) 642-1080
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12811
NY
Other
Enumeration date
03/15/2007
Last updated
07/08/2007
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