Provider Demographics
NPI:1386874303
Name:HAINES, JESSICA MINK (LMT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MINK
Last Name:HAINES
Suffix:
Gender:F
Credentials:LMT
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Mailing Address - Street 1:2231 BEMISS RD STE B
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-4812
Mailing Address - Country:US
Mailing Address - Phone:229-241-9300
Mailing Address - Fax:229-241-9301
Practice Address - Street 1:2420 BEMISS RD STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-4809
Practice Address - Country:US
Practice Address - Phone:229-293-9511
Practice Address - Fax:229-293-9141
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2011-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT 00892225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist