MEDICARE: JESSICA TAYLOR KNOX LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1275365041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA TAYLOR KNOX LMT

Provider Business Mailing Address
First Line	:	2940 65TH ST E
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2040
Country	:	US
Telephone Number	:	651-451-1012
Fax Number	:	651-453-1543

Provider Business Practice Location Address
First Line	:	2940 65TH ST E
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2040
Country	:	US
Telephone Number	:	651-451-1012
Fax Number	:	651-453-1543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/19/2024

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