MEDICARE: MRS. JENNIFER RAE STUART MMT

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	7158	AR

General Provider Information

NPI Number	:	1023743630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER RAE STUART MMT

Provider Business Mailing Address
First Line	:	3301 FRESNO ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-4460
Country	:	US
Telephone Number	:	479-459-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 ROGERS AVE STE E
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2986
Country	:	US
Telephone Number	:	479-459-0005
Fax Number	:

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

Provider Enumeration Date	:	07/18/2022
Last Update Date	:	11/28/2023

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