MEDICARE: JENNIFER NEWBY LMT #12297

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	12297	NC

General Provider Information

NPI Number	:	1659938058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NEWBY LMT #12297

Provider Business Mailing Address
First Line	:	3 WOODFIN AVE
Second Line	:
City	:	WOODFIN
State	:	NC
Zip	:	28804-3033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 WOODFIN AVE
Second Line	:
City	:	WOODFIN
State	:	NC
Zip	:	28804-3033
Country	:	US
Telephone Number	:	914-844-9971
Fax Number	:

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

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	05/22/2019

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