Provider Demographics
NPI:1720614159
Name:FLORES-DRENNEN, RHIANNON (LMBT)
Entity type:Individual
Prefix:
First Name:RHIANNON
Middle Name:
Last Name:FLORES-DRENNEN
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 KINGS HWY E FL 2
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2038
Mailing Address - Country:US
Mailing Address - Phone:856-857-7535
Mailing Address - Fax:
Practice Address - Street 1:225 KINGS HWY E FL 2
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2038
Practice Address - Country:US
Practice Address - Phone:856-857-7535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00767200225700000X
PAMSG009072225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ18KT00767200OtherNEW JERSEY BOARD OF MASSAGE & BODYWORK THERAPY
PAMSG009072OtherPENNSYLVANIA BOARD OF MASSAGE THERAPY