Provider Demographics
NPI:1124496849
Name:GANSNEDER, JACOB EDWARD VIII (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:EDWARD
Last Name:GANSNEDER
Suffix:VIII
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3242 AVEBURY LN
Mailing Address - Street 2:
Mailing Address - City:KESWICK
Mailing Address - State:VA
Mailing Address - Zip Code:22947-9103
Mailing Address - Country:US
Mailing Address - Phone:434-981-4968
Mailing Address - Fax:
Practice Address - Street 1:3242 AVEBURY LN
Practice Address - Street 2:
Practice Address - City:KESWICK
Practice Address - State:VA
Practice Address - Zip Code:22947-9103
Practice Address - Country:US
Practice Address - Phone:434-981-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019008724174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist