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General NPI Number Information
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NPI Number | 1578359246
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Entity Type | Individual
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Provider Name | JENNIFER MARIE SPROCK LMT
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Gender | Female
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 12000 FORD RD STE 250
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City | DALLAS
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State | TX
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Zip | 75234-7256
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Country | US
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Telephone | 469-857-8788
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Fax | 469-257-1020
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Provider Business Mailing Address
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Address Line | 3701 SYRACUSE DR
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City | DENTON
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State | TX
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Zip | 76210-8798
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Country | US
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Telephone | 937-603-1107
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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 | MT134306
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License Number State | TX
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