Provider Demographics
NPI:1073228276
Name:GREENMAN, JENNIFER (CMT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:GREENMAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:MS
Other - First Name:JAE
Other - Middle Name:
Other - Last Name:GREENMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:41 ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3012
Mailing Address - Country:US
Mailing Address - Phone:415-361-9044
Mailing Address - Fax:
Practice Address - Street 1:12 FAIR AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5015
Practice Address - Country:US
Practice Address - Phone:415-361-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55884225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist