Provider Demographics
NPI:1053855437
Name:FRANCO, JENNIFER (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FRANCO
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7814
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-7814
Mailing Address - Country:US
Mailing Address - Phone:307-690-5257
Mailing Address - Fax:
Practice Address - Street 1:3940 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-9195
Practice Address - Country:US
Practice Address - Phone:307-690-5257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-10231225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist