Provider Demographics
NPI:1114691433
Name:SANCHEZ, JESSICA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 NEW YORK AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-1653
Mailing Address - Country:US
Mailing Address - Phone:551-358-0224
Mailing Address - Fax:
Practice Address - Street 1:160 NEW YORK AVE APT 1
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-1653
Practice Address - Country:US
Practice Address - Phone:551-358-0224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00311900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
18KT00311900OtherMASSAGE