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General NPI Number Information
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NPI Number | 1306351838
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Entity Type | Individual
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Provider Name | JESSICA WILSON GOODNIGHT LMT
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Gender | Female
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 6559 W 66TH AVE
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City | ARVADA
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State | CO
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Zip | 80003-4524
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Country | US
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Telephone | 303-668-7773
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Fax |
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Provider Business Mailing Address
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Address Line | 6559 W 66TH AVE
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City | ARVADA
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State | CO
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Zip | 80003-4524
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Country | US
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Telephone | 303-668-7773
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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 | MT.0019167
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License Number State | CO
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