Provider Demographics
NPI:1952599474
Name:FREDERIC VERSWIJVER, INC
Entity Type:Organization
Organization Name:FREDERIC VERSWIJVER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:VERSWIJVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LMT
Authorized Official - Phone:505-983-2341
Mailing Address - Street 1:1807 SECOND STREET #46
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-983-2341
Mailing Address - Fax:505-983-4578
Practice Address - Street 1:1807 SECOND STREET #46
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-983-2341
Practice Address - Fax:505-983-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0249225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty