Provider Demographics
NPI:1700097763
Name:MASON, ELAINE B (CMT)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:B
Last Name:MASON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:HEALTHY
Other - Middle Name:LIFESTYLES
Other - Last Name:MASSAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:339 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1411
Mailing Address - Country:US
Mailing Address - Phone:856-468-1942
Mailing Address - Fax:
Practice Address - Street 1:339 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090-1411
Practice Address - Country:US
Practice Address - Phone:856-468-1942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist