Provider Demographics
NPI:1073993812
Name:JOYCE, JEANIE BAUGHMAN (LMT)
Entity Type:Individual
Prefix:
First Name:JEANIE
Middle Name:BAUGHMAN
Last Name:JOYCE
Suffix:
Gender:F
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:PO BOX 170956
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-0035
Mailing Address - Country:US
Mailing Address - Phone:864-804-6395
Mailing Address - Fax:864-551-2985
Practice Address - Street 1:145 TRADD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-5085
Practice Address - Country:US
Practice Address - Phone:864-804-6395
Practice Address - Fax:864-551-2985
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-07
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8612225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist