MEDICARE: JESSICA SANCHEZ 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
1	225700000X	Massage Therapist	MA60282856	WA

General Provider Information

NPI Number	:	1619239357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SANCHEZ LMP

Provider Business Mailing Address
First Line	:	1824 SHAMROCK DR
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531-8824
Country	:	US
Telephone Number	:	360-623-5072
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 TUMWATER BLVD SE
Second Line	:	B106
City	:	TUMWATER
State	:	WA
Zip	:	98501-6400
Country	:	US
Telephone Number	:	360-786-8600
Fax Number	:

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

Provider Enumeration Date	:	06/08/2012
Last Update Date	:	06/08/2012

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