Provider Demographics
NPI:1073330544
Name:RHODES, JENIFER LYNN (LMT)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:LYNN
Last Name:RHODES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 PICKLES FORD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MO
Mailing Address - Zip Code:63077-4451
Mailing Address - Country:US
Mailing Address - Phone:636-283-1717
Mailing Address - Fax:
Practice Address - Street 1:442 PICKLES FORD RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MO
Practice Address - Zip Code:63077-4451
Practice Address - Country:US
Practice Address - Phone:636-283-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019010183225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist