MEDICARE: JENNIFER HERMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT.0014178	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT.0014178	OTHER	CO	MASSAGE THERAPIST

General Provider Information

NPI Number	:	1013513464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HERMAN

Provider Business Mailing Address
First Line	:	578 WASHINGTON BLVD # 1107
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	578 WASHINGTON BLVD # 1107
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5421
Country	:	US
Telephone Number	:	970-846-1481
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	12/10/2020

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Directions to “ JENNIFER HERMAN ” Practice Location

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