Individual
MICHELLE VIEIRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
52 PINE DR, CEDAR GROVE, NJ 07009-1036
(862) 216-0872
Mailing address
52 PINE DR, CEDAR GROVE, NJ 07009-1036
(862) 216-0872
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
40QB00323100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40QB00323100
PHYSICAL THERAPY LICENSE
NJ
Enumeration date
03/02/2017
Last updated
03/02/2017
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