Provider Demographics
NPI:1962117192
Name:REDONDO, DANTE PASCUAL (MT, LMT)
Entity type:Individual
Prefix:PROF
First Name:DANTE
Middle Name:PASCUAL
Last Name:REDONDO
Suffix:
Gender:M
Credentials:MT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 RISLER ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559-2136
Mailing Address - Country:US
Mailing Address - Phone:310-430-4588
Mailing Address - Fax:
Practice Address - Street 1:21 RISLER ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:NJ
Practice Address - Zip Code:08559-2136
Practice Address - Country:US
Practice Address - Phone:310-430-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01358500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist