Provider Demographics
NPI:1558100925
Name:HERTEL, CHLOE GRACE (LMT)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:GRACE
Last Name:HERTEL
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 1:4440 SHIMERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1808
Mailing Address - Country:US
Mailing Address - Phone:716-633-2036
Mailing Address - Fax:
Practice Address - Street 1:4440 SHIMERVILLE RD
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1808
Practice Address - Country:US
Practice Address - Phone:716-633-2036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033507225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist