Provider Demographics
NPI:1083153548
Name:SMETANICK, JENNIFER (LMT, BCTMB)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SMETANICK
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11491 GILPIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-2157
Mailing Address - Country:US
Mailing Address - Phone:443-850-6726
Mailing Address - Fax:
Practice Address - Street 1:10329 WASHINGTON ST
Practice Address - Street 2:LOT 124
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2003
Practice Address - Country:US
Practice Address - Phone:720-443-0601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017587225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist