Provider Demographics
NPI:1790413656
Name:MAGEE, AUTUMN GRACE (LMT)
Entity Type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:GRACE
Last Name:MAGEE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:AUTUMN
Other - Middle Name:GRACE
Other - Last Name:SOLITARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500B HORNBERGER AVE # B
Mailing Address - Street 2:
Mailing Address - City:ROEBLING
Mailing Address - State:NJ
Mailing Address - Zip Code:08554-1108
Mailing Address - Country:US
Mailing Address - Phone:856-899-3583
Mailing Address - Fax:
Practice Address - Street 1:3 THIRD ST # 280
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1370
Practice Address - Country:US
Practice Address - Phone:856-899-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00230400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist