Provider Demographics
NPI:1720614159
Name:FLORES-DRENNEN, RHIANNON (LMBT)
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:
Last Name:FLORES-DRENNEN
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 E MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2325
Mailing Address - Country:US
Mailing Address - Phone:856-857-7535
Mailing Address - Fax:
Practice Address - Street 1:8 E MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2325
Practice Address - Country:US
Practice Address - Phone:856-857-7535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG009072225700000X
NJ18KT00767200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMSG009072OtherPENNSYLVANIA BOARD OF MASSAGE THERAPY
NJ18KT00767200OtherNEW JERSEY BOARD OF MASSAGE & BODYWORK THERAPY