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General NPI Number Information
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NPI Number | 1659749836
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Entity Type | Individual
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Provider Name | JENNIFER STOCK LCMT
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Gender | Female
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 3072 EVERGREEN PKWY 100
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City | EVERGREEN
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State | CO
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Zip | 80439-7979
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Country | US
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Telephone | 303-674-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 28157 KNOWLES RD
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City | EVERGREEN
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State | CO
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Zip | 80439-8390
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Country | US
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Telephone |
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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.0004906
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License Number State | CO
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