MEDICARE: JESSICA JO BLINKINSOP LMT

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	MT.0025327	CO

General Provider Information

NPI Number	:	1912616137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA JO BLINKINSOP LMT

Provider Business Mailing Address
First Line	:	13000 WOODCHUCK DR
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-8970
Country	:	US
Telephone Number	:	951-303-5002
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 CROSSING DR STE 101
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-2629
Country	:	US
Telephone Number	:	951-303-5002
Fax Number	:

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

Provider Enumeration Date	:	11/16/2022
Last Update Date	:	11/16/2022

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