Provider Demographics
NPI:1336325836
Name:MANKIN, JESSICA LEE (LMT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:MANKIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JESSIKA
Other - Middle Name:LEE
Other - Last Name:MANKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:155 W HARVARD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5200
Mailing Address - Country:US
Mailing Address - Phone:970-690-4946
Mailing Address - Fax:
Practice Address - Street 1:155 W HARVARD ST STE 102
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5200
Practice Address - Country:US
Practice Address - Phone:970-690-4946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0004892225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist