Provider Demographics
NPI:1275272841
Name:MYHRE, REBECCA LYNN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:MYHRE
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 1:207 OAK SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08825-4135
Mailing Address - Country:US
Mailing Address - Phone:908-323-0775
Mailing Address - Fax:
Practice Address - Street 1:1059 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:RINGOES
Practice Address - State:NJ
Practice Address - Zip Code:08551-1041
Practice Address - Country:US
Practice Address - Phone:908-892-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01402800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ18KT01402800OtherMASSAGE THERAPIST