Provider Demographics
NPI:1699596718
Name:JENNINGS, AUSTIN ROBERT (LMT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:ROBERT
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4158
Mailing Address - Country:US
Mailing Address - Phone:509-837-2222
Mailing Address - Fax:509-232-3336
Practice Address - Street 1:1123 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4158
Practice Address - Country:US
Practice Address - Phone:509-837-2222
Practice Address - Fax:509-232-3336
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61472535225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist