Provider Demographics
NPI:1336664853
Name:ZUCKERMAN, EVELYN
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 RUNNALS RD
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-9234
Mailing Address - Country:US
Mailing Address - Phone:1802-295-6653
Mailing Address - Fax:
Practice Address - Street 1:216 RUNNALS RD.
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-0500
Practice Address - Country:US
Practice Address - Phone:802-295-6653
Practice Address - Fax:802-295-6653
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-05
Last Update Date:2017-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
019941-00OtherNATIONAL CERTIFICATION BOARD FOR THERAPEUTIC MASSAGE AND BODYWORK