Doctor Name: | JENNIFER STOCK |
NPI Number: | 1659749836 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCMT |
License Number: | MT.0004906 |
Business Practice Address: | 3072 Evergreen Pkwy 100 Evergreen, CO - 804397979 |
Business Phone Number: | 3036749800 |
Business Fax Number: | |
Mailing Address: | 28157 Knowles Rd, EVERGREEN |
State: | CO |
Postal Code: | 804398390 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/04/2015 |
NPI Last Update Date: | 09/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MT.0004906 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
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. |