Provider Demographics
NPI:1679994040
Name:PREVITE, KRISSIE (LMT)
Entity type:Individual
Prefix:MS
First Name:KRISSIE
Middle Name:
Last Name:PREVITE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 OCEAN BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3346
Mailing Address - Country:US
Mailing Address - Phone:609-489-2011
Mailing Address - Fax:
Practice Address - Street 1:53 OCEAN BREEZE CT
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3346
Practice Address - Country:US
Practice Address - Phone:609-489-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00592600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist