Provider Demographics
NPI:1942450390
Name:BRATHWAITE, XIOMARA (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:XIOMARA
Middle Name:
Last Name:BRATHWAITE
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1928
Mailing Address - Country:US
Mailing Address - Phone:856-428-8811
Mailing Address - Fax:
Practice Address - Street 1:1 E MEADOWBROOK CIR
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1669
Practice Address - Country:US
Practice Address - Phone:917-597-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017047225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist