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General NPI Number Information
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NPI Number | 1942556766
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Entity Type | Individual
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Provider Name | JENNA LYNN PETERSON LMT
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Gender | Female
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Dates
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Enumeration Date | 07/30/2012
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 325 N ALMA SCHOOL RD STE 3
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City | CHANDLER
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State | AZ
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Zip | 85224-4379
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Country | US
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Telephone | 260-413-4757
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Fax |
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Provider Business Mailing Address
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Address Line | 533 W GUADALUPE RD UNIT 2077
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City | MESA
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State | AZ
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Zip | 85210-7784
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Country | US
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Telephone | 260-413-4757
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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-16104
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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