MEDICARE: MRS. JENNY REBECCA MOHR FRIEDEL L.M.T

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	4870-146	WI

General Provider Information

NPI Number	:	1104184712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNY REBECCA MOHR FRIEDEL L.M.T

Provider Business Mailing Address
First Line	:	221 JEFFERSON AVE
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-4130
Country	:	US
Telephone Number	:	608-754-4235
Fax Number	:

Provider Business Practice Location Address
First Line	:	1831 W COURT ST
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53548-3406
Country	:	US
Telephone Number	:	608-754-7463
Fax Number	:	608-754-1437

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

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	05/02/2012

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