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NPI Code Detail

MEDICARE: JACQUELINE DUNCAN DU FRESNE MASSAGE THERAPIST

MEDICARE: JACQUELINE DUNCAN DU FRESNE MASSAGE THERAPIST
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 Therapist9315CO

General Provider Information

NPI Number : 1649786526
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE DUNCAN DU FRESNE MASSAGE THERAPIST
Provider Business Mailing Address
First Line : 4791 BUNCHBERRY LN
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80917-1372
Country : US
Telephone Number : 719-231-2389
Fax Number :
Provider Business Practice Location Address
First Line : 4617 AUSTIN BLUFFS PKWY
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-2937
Country : US
Telephone Number : 719-231-2389
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2017
Last Update Date : 12/14/2017

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