Doctor Name: | MISS LYDIA JENKINS |
NPI Number: | 1679830616 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MT114234 |
Business Practice Address: | 3975 State Highway 6 S Suite 700 College Station, TX - 77845 |
Business Phone Number: | 9796962000 |
Business Fax Number: | |
Mailing Address: | 4345 Carter Creek Dr., 9 BRYAN |
State: | TX |
Postal Code: | 77802 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/16/2012 |
NPI Last Update Date: | 04/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MT114234 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
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. |