Healthcare Provider Details

I. General information

NPI: 1548016686
Provider Name (Legal Business Name): MASSAGE BY JESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 COUNTRY DAY RD STE B
CHESTER MD
21619-2684
US

IV. Provider business mailing address

302 CLAIBORNE FIELDS DR
CENTREVILLE MD
21617-2504
US

V. Phone/Fax

Practice location:
  • Phone: 410-200-5892
  • Fax:
Mailing address:
  • Phone: 443-988-1479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESSICA THOMAS
Title or Position: OWNER
Credential:
Phone: 410-200-5892