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General NPI Number Information
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NPI Number | 1932601390
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Entity Type | Individual
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Provider Name | JESSICA KNOX LMT NMT
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Gender | Female
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 16515 S 40TH ST STE 139
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City | PHOENIX
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State | AZ
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Zip | 85048-0560
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Country | US
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Telephone | 480-963-1853
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Fax |
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Provider Business Mailing Address
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Address Line | 2040 S ALMA SCHOOL RD
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City | CHANDLER
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State | AZ
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Zip | 85286-7075
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Country | US
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Telephone | 505-453-5740
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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 | MT19466
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License Number State | AZ
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