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General NPI Number Information
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NPI Number | 1447064019
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Entity Type | Individual
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Provider Name | JENNIFER C BOODT LMT
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Gender | Female
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 6769 COURTLAND DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-7242
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Country | US
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Telephone | 616-863-9482
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Fax |
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Provider Business Mailing Address
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Address Line | 3371 HAMPTON DOWNS DR SE
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City | KENTWOOD
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State | MI
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Zip | 49512-8091
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Country | US
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Telephone | 269-876-8242
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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 | 7501006322
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License Number State | MI
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