MEDICARE: JENNIFER DUKE 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	MA00021319	WA

General Provider Information

NPI Number	:	1841403920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DUKE LMP

Provider Business Mailing Address
First Line	:	PO BOX 13265
Second Line	:
City	:	BURTON
State	:	WA
Zip	:	98013-0265
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 10TH AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-4105
Country	:	US
Telephone Number	:	206-860-9090
Fax Number	:

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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