Provider Demographics
NPI:1316670888
Name:CHILLRUD, ALASTAIR LEOPOLD (MASSAGE THERAPY LLC)
Entity type:Individual
Prefix:
First Name:ALASTAIR
Middle Name:LEOPOLD
Last Name:CHILLRUD
Suffix:
Gender:M
Credentials:MASSAGE THERAPY LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 STERLING AVE
Mailing Address - Street 2:
Mailing Address - City:TAPPAN
Mailing Address - State:NY
Mailing Address - Zip Code:10983-1914
Mailing Address - Country:US
Mailing Address - Phone:845-664-1996
Mailing Address - Fax:
Practice Address - Street 1:33 STERLING AVE
Practice Address - Street 2:
Practice Address - City:TAPPAN
Practice Address - State:NY
Practice Address - Zip Code:10983-1914
Practice Address - Country:US
Practice Address - Phone:845-664-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01439900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist