Provider Demographics
NPI:1063548170
Name:KING, JESSICA MARIE (CMT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:KING
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1155
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80502-1155
Mailing Address - Country:US
Mailing Address - Phone:303-775-2162
Mailing Address - Fax:
Practice Address - Street 1:1930 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1984
Practice Address - Country:US
Practice Address - Phone:303-775-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist