Provider Demographics
NPI:1174095301
Name:WILLIAMS, CHANTAL G (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:CHANTAL
Middle Name:G
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2136
Mailing Address - Country:US
Mailing Address - Phone:760-534-1005
Mailing Address - Fax:
Practice Address - Street 1:340 RAMAPO VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2711
Practice Address - Country:US
Practice Address - Phone:201-651-9100
Practice Address - Fax:201-651-1142
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01042800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist