Provider Demographics
NPI:1912775909
Name:TOUSSAINT, JEAN NELSON (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:NELSON
Last Name:TOUSSAINT
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2123
Mailing Address - Country:US
Mailing Address - Phone:917-913-7442
Mailing Address - Fax:
Practice Address - Street 1:194 LOCUST DR
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2123
Practice Address - Country:US
Practice Address - Phone:917-913-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028022-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty