Provider Demographics
NPI:1639414980
Name:MURIEL, CHARISSE NICOLE (LMT, RMT)
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:NICOLE
Last Name:MURIEL
Suffix:
Gender:F
Credentials:LMT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5923
Mailing Address - Country:US
Mailing Address - Phone:860-794-4888
Mailing Address - Fax:860-454-4263
Practice Address - Street 1:100 TOLLAND TPKE
Practice Address - Street 2:SUITE 201
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1766
Practice Address - Country:US
Practice Address - Phone:860-794-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007324225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist