Provider Demographics
NPI:1033603865
Name:GANTHER, JOLYNN M (LMT)
Entity Type:Individual
Prefix:
First Name:JOLYNN
Middle Name:M
Last Name:GANTHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JOLYNN
Other - Middle Name:MARIE
Other - Last Name:GANTHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT, CMT
Mailing Address - Street 1:1660 STICKNEY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-1061
Mailing Address - Country:US
Mailing Address - Phone:612-226-9161
Mailing Address - Fax:
Practice Address - Street 1:117 3RD ST W
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1116
Practice Address - Country:US
Practice Address - Phone:651-437-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist