Provider Demographics
NPI:1194571588
Name:WELLMAN, JENNIFER ANNE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANNE
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
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Mailing Address - Street 1:3003 TRANSPORT ST SE # HOUSE148
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4307
Mailing Address - Country:US
Mailing Address - Phone:505-300-7310
Mailing Address - Fax:505-300-7310
Practice Address - Street 1:123 RICHMOND DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2235
Practice Address - Country:US
Practice Address - Phone:505-300-7310
Practice Address - Fax:505-300-7310
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMT-2023-0288225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist