Provider Demographics
NPI:1083849749
Name:NORCROSS, JENNIFER (LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:NORCROSS
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 1:246 STEFAN DR APT E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2480
Mailing Address - Country:US
Mailing Address - Phone:843-795-6720
Mailing Address - Fax:
Practice Address - Street 1:246 STEFAN DR
Practice Address - Street 2:UNIT E
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2480
Practice Address - Country:US
Practice Address - Phone:843-795-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5715225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist