Provider Demographics
NPI:1154637544
Name:MYSZEWSKI, JENNIFER (LMT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:MYSZEWSKI
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 1:2355 VANDERBILT BEACH RD
Mailing Address - Street 2:SUITE 146
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2766
Mailing Address - Country:US
Mailing Address - Phone:239-514-2211
Mailing Address - Fax:239-514-0609
Practice Address - Street 1:2355 VANDERBILT BEACH RD
Practice Address - Street 2:SUITE 146
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2766
Practice Address - Country:US
Practice Address - Phone:239-514-2211
Practice Address - Fax:239-514-0609
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60159225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist