Provider Demographics
NPI:1558909721
Name:BRUMBLE, THERESA MARIE (CMMP, LMT, RT(R)(CT))
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:BRUMBLE
Suffix:
Gender:F
Credentials:CMMP, LMT, RT(R)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 NEW RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244
Mailing Address - Country:US
Mailing Address - Phone:609-365-2112
Mailing Address - Fax:
Practice Address - Street 1:415 NEW RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244
Practice Address - Country:US
Practice Address - Phone:609-365-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00816000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist