| Doctor Name: | MR. JACOB JON HENNESS |
| NPI Number: | 1407985393 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMT MA |
| License Number: | MT04134 |
| Business Practice Address: | 3543 N 7 St Phoenix, AZ - 85014 |
| Business Phone Number: | 6022638484 |
| Business Fax Number: | 6022633697 |
| Mailing Address: | 5638 W Glenrosa, PHOENIX |
| State: | AZ |
| Postal Code: | 85031 |
| Phone Number: | 6232479621 |
| Fax Number: | |
| NPI Enumeration Date: | 03/05/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | MT04134 |
| 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. |