Provider Demographics
NPI:1518261437
Name:VESSUP, LINDA D (CMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:VESSUP
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NASSAU ST
Mailing Address - Street 2:SUITE 247
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-4509
Mailing Address - Country:US
Mailing Address - Phone:609-532-1542
Mailing Address - Fax:
Practice Address - Street 1:20 NASSAU ST
Practice Address - Street 2:SUITE 247
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-4509
Practice Address - Country:US
Practice Address - Phone:609-532-1542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00136100173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist