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General NPI Number Information
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NPI Number | 1295425643
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Entity Type | Individual
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Provider Name | JENSEN AGUINALDO LMT
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Gender | Male
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Dates
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Enumeration Date | 05/09/2023
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 836 E 65TH ST STE 20
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City | SAVANNAH
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State | GA
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Zip | 31405-4493
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Country | US
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Telephone | 808-258-5492
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Fax |
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Provider Business Mailing Address
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Address Line | 5798 OGEECHEE RD APT 124
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City | SAVANNAH
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State | GA
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Zip | 31405-9532
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Country | US
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Telephone | 808-258-5492
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 013537
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License Number State | GA
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