MEDICARE: JOSHUA JERNIGAN

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	MT135283	TX

General Provider Information

NPI Number	:	1578237392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA JERNIGAN

Provider Business Mailing Address
First Line	:	8801 GLENCREST ST APT 6201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77061-3033
Country	:	US
Telephone Number	:	832-273-4728
Fax Number	:

Provider Business Practice Location Address
First Line	:	8801 GLENCREST ST APT 6201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77061-3033
Country	:	US
Telephone Number	:	832-273-4728
Fax Number	:

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

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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Directions to “ JOSHUA JERNIGAN ” Practice Location

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