Healthcare Provider Details

I. General information

NPI: 1770414211
Provider Name (Legal Business Name): JEANETTA JOSEPH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 K ST NW FL 2
WASHINGTON DC
20005-4094
US

IV. Provider business mailing address

3510 METZEROTT RD
COLLEGE PARK MD
20740-4436
US

V. Phone/Fax

Practice location:
  • Phone: 202-972-8004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT0595
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: