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General NPI Number Information
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NPI Number | 1790805638
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Entity Type | Individual
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Provider Name | JAMIE LYNN HRYNCIW MT
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Gender | Female
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Dates
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Enumeration Date | 03/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1320 E STATE ST STE B
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City | FREMONT
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State | OH
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Zip | 43420-4366
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Country | US
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Telephone | 419-332-6840
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 FENWICK ST
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City | FREMONT
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State | OH
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Zip | 43420-2218
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Country | US
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Telephone | 419-332-0052
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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 | 33. 011514
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License Number State | OH
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