Healthcare Provider Details

I. General information

NPI: 1669045191
Provider Name (Legal Business Name): JENNIFER CHRISTOPHEL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23789 GARRETT HWY
MC HENRY MD
21541-1338
US

IV. Provider business mailing address

331 ORD ST
SALISBURY PA
15558-9004
US

V. Phone/Fax

Practice location:
  • Phone: 814-242-6418
  • Fax:
Mailing address:
  • Phone: 814-242-6418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019018358
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT2000029
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG014199
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: