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NPI Code Detail

MEDICARE: JENNIFER GANTENBEIN LMP

MEDICARE: JENNIFER GANTENBEIN LMP
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
1225700000XMassage TherapistMA00014857WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11254GAOTHERWAREGENCE RIDER NUMBER

General Provider Information

NPI Number : 1598862187
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER GANTENBEIN LMP
Provider Business Mailing Address
First Line : 17614 157TH PL SE
Second Line :
City : MONROE
State : WA
Zip : 98272-1603
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 328 W MAIN ST
Second Line :
City : MONROE
State : WA
Zip : 98272-1812
Country : US
Telephone Number : 360-794-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2006
Last Update Date : 07/08/2007

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Directions to “ JENNIFER GANTENBEIN LMP” Practice Location

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