Provider Demographics
NPI:1073933149
Name:VOIGT, JESSIE (LMT)
Entity Type:Individual
Prefix:MR
First Name:JESSIE
Middle Name:
Last Name:VOIGT
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 1:2525 E 104TH AVE UNIT 913
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-6182
Mailing Address - Country:US
Mailing Address - Phone:920-319-6825
Mailing Address - Fax:
Practice Address - Street 1:2525 E 104TH AVE UNIT 913
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-6182
Practice Address - Country:US
Practice Address - Phone:920-319-6825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0016271225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist