Provider Demographics
NPI:1932544251
Name:STYS, THERESA (LMT)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:STYS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-7014
Mailing Address - Country:US
Mailing Address - Phone:732-356-7482
Mailing Address - Fax:
Practice Address - Street 1:1110 HAMILTON BLVD
Practice Address - Street 2:SUITE 1C 1D
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2000
Practice Address - Country:US
Practice Address - Phone:908-300-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00492100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist