Provider Demographics
NPI:1730913633
Name:VIEIRA, NOELLE LUCY (LMT)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:LUCY
Last Name:VIEIRA
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 1:808 CYPRUS CT
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-2750
Mailing Address - Country:US
Mailing Address - Phone:848-218-9729
Mailing Address - Fax:
Practice Address - Street 1:808 CYPRUS CT
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-2750
Practice Address - Country:US
Practice Address - Phone:848-218-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01491600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist