Provider Demographics
NPI:1548812118
Name:SOUSA, ELIENE ALVES (LMT)
Entity type:Individual
Prefix:
First Name:ELIENE
Middle Name:ALVES
Last Name:SOUSA
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 1:85 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2408
Mailing Address - Country:US
Mailing Address - Phone:908-209-3565
Mailing Address - Fax:
Practice Address - Street 1:511 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-2202
Practice Address - Country:US
Practice Address - Phone:908-558-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01191300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist