Provider Demographics
NPI:1376087056
Name:ATWOOD, JANIS ILENE (LMT)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:ILENE
Last Name:ATWOOD
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 1:108 PASADENA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2966
Mailing Address - Country:US
Mailing Address - Phone:859-278-8000
Mailing Address - Fax:
Practice Address - Street 1:108 PASADENA DR STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2966
Practice Address - Country:US
Practice Address - Phone:859-278-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY107221225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist