Doctor Name: | JENNIFER VANDERSTOUW |
NPI Number: | 1346694007 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.M.T. |
License Number: | MT-12206 |
Business Practice Address: | 1615 E Warner Rd Ste 3 Tempe, AZ - 852844500 |
Business Phone Number: | 4802835243 |
Business Fax Number: | |
Mailing Address: | 3201 N 38th St Unit 27, PHOENIX |
State: | AZ |
Postal Code: | 850186358 |
Phone Number: | 4802835243 |
Fax Number: | |
NPI Enumeration Date: | 04/19/2016 |
NPI Last Update Date: | 04/19/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MT-12206 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |