MEDICARE: JENNIFER SHAW TRIMBLE 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	MT000791	GA

General Provider Information

NPI Number	:	1184895450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SHAW TRIMBLE LMT

Provider Business Mailing Address
First Line	:	220 SANDY SPRINGS CIR NE STE 141
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-3861
Country	:	US
Telephone Number	:	404-421-9131
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 SANDY SPRINGS CIR NE STE 141
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-3861
Country	:	US
Telephone Number	:	404-421-9131
Fax Number	:

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

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	03/14/2008

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