Healthcare Provider Details

I. General information

NPI: 1700377017
Provider Name (Legal Business Name): JASMINE BOSSIE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 17TH ST NW # 10
WASHINGTON DC
20010-2135
US

IV. Provider business mailing address

11100 PINION CT
NORTH POTOMAC MD
20878-2565
US

V. Phone/Fax

Practice location:
  • Phone: 202-436-1279
  • Fax:
Mailing address:
  • Phone: 786-988-1867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM05925
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: