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General NPI Number Information
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NPI Number | 1588168140
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Entity Type | Individual
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Provider Name | JENNI GANT
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Gender | Female
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 38700 SE RIVER ST STE 300
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City | SNOQUALMIE
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State | WA
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Zip | 98065
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Country | US
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Telephone | 425-208-5048
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Fax |
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Provider Business Mailing Address
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Address Line | 7702 MOON VALLEY RD SE
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City | NORTH BEND
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State | WA
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Zip | 98045-7929
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Country | US
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Telephone | 206-947-0921
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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 | 60826088
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License Number State | WA
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