Provider Demographics
NPI:1326394636
Name:NYNAS, JENNIFER (RMT, CNMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:NYNAS
Suffix:
Gender:F
Credentials:RMT, CNMT
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 350
Mailing Address - Street 2:
Mailing Address - City:PALMER LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80133-0350
Mailing Address - Country:US
Mailing Address - Phone:720-273-8855
Mailing Address - Fax:
Practice Address - Street 1:710 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2621
Practice Address - Country:US
Practice Address - Phone:720-273-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11575225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist