Provider Demographics
NPI:1952824542
Name:KURTZ, CHANTELLE JOY (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CHANTELLE
Middle Name:JOY
Last Name:KURTZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:CHANTELLE
Other - Middle Name:JOY
Other - Last Name:KURTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:20170 PINES BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1262
Mailing Address - Country:US
Mailing Address - Phone:954-900-1535
Mailing Address - Fax:
Practice Address - Street 1:20170 PINES BLVD STE 301
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1262
Practice Address - Country:US
Practice Address - Phone:954-900-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA14927225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist