Provider Demographics
NPI:1295316354
Name:DENISE, JOHNGARRET VANDERVEER (LMT)
Entity type:Individual
Prefix:
First Name:JOHNGARRET
Middle Name:VANDERVEER
Last Name:DENISE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 POTTERS PL
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-5524
Mailing Address - Country:US
Mailing Address - Phone:609-977-4202
Mailing Address - Fax:
Practice Address - Street 1:330 N HARRISON ST STE 6
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3500
Practice Address - Country:US
Practice Address - Phone:609-977-4202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01365800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty