| Organization Name: | FREDERIC VERSWIJVER, INC |
| NPI Number: | 1952599474 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FREDERIC VERSWIJVER (DIRECTOR OWNER OF CORPORATION) |
| Mailing Address: | 1807 Second Street #46 Santa Fe |
| State: | NM US |
| Postal Code: | 87505 |
| Phone Number: | 5059832341 |
| Fax Number: | 5059834578 |
| NPI Enumeration Date: | 10/10/2007 |
| NPI Last Update Date: | 10/10/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | 0249 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |