MEDICARE: JESSICA ROSALES LMT

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-29415	AZ

General Provider Information

NPI Number	:	1104687441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ROSALES LMT

Provider Business Mailing Address
First Line	:	1846 E INNOVATION PARK DR STE 100
Second Line	:
City	:	ORO VALLEY
State	:	AZ
Zip	:	85755-1963
Country	:	US
Telephone Number	:	602-689-7426
Fax Number	:

Provider Business Practice Location Address
First Line	:	152 N POWER RD STE 2
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85205-8436
Country	:	US
Telephone Number	:	602-689-7426
Fax Number	:

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

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	01/23/2024

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