MEDICARE: JENNIFER JOLLEY 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	MT111813	TX

General Provider Information

NPI Number	:	1356734321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JOLLEY LMT

Provider Business Mailing Address
First Line	:	3657 MALACHI WAY
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-4500
Country	:	US
Telephone Number	:	512-568-8862
Fax Number	:

Provider Business Practice Location Address
First Line	:	6839 OLD JACKSONVILLE HWY
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-0565
Country	:	US
Telephone Number	:	903-343-3935
Fax Number	:

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

Provider Enumeration Date	:	03/14/2015
Last Update Date	:	03/14/2015

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Directions to “ JENNIFER JOLLEY LMT” Practice Location

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