Healthcare Provider Details

I. General information

NPI: 1477536795
Provider Name (Legal Business Name): JENNIFER DUMAN MMT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W FRONT ST SUITE # 9
TRAVERSE CITY MI
49684-2259
US

IV. Provider business mailing address

401 W FRONT ST SUITE # 9
TRAVERSE CITY MI
49684-2259
US

V. Phone/Fax

Practice location:
  • Phone: 231-995-9733
  • Fax:
Mailing address:
  • Phone: 231-995-9733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: