Provider Demographics
NPI:1811120637
Name:NEWCOMB, JAYNE ALFREDA (LMT)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:ALFREDA
Last Name:NEWCOMB
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5001 AMERICAN BLVD W STE 945
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1162
Mailing Address - Country:US
Mailing Address - Phone:952-835-6653
Mailing Address - Fax:952-835-3895
Practice Address - Street 1:5001 AMERICAN BLVD W STE 945
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1162
Practice Address - Country:US
Practice Address - Phone:952-835-6653
Practice Address - Fax:952-835-3895
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist