Provider Demographics
NPI:1588010888
Name:BRUNSON, ROCHELLE LAVERNE (LMT)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:LAVERNE
Last Name:BRUNSON
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 1:545 MORRIS AVE
Mailing Address - Street 2:APT. 553A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1072
Mailing Address - Country:US
Mailing Address - Phone:862-216-8342
Mailing Address - Fax:
Practice Address - Street 1:2130 MILLBURN AVE.
Practice Address - Street 2:SUITE C8
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040
Practice Address - Country:US
Practice Address - Phone:862-216-8342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist