Provider Demographics
NPI:1518130301
Name:TROMBLY, JENNIE MAE (MT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:MAE
Last Name:TROMBLY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32530 PRESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-9718
Mailing Address - Country:US
Mailing Address - Phone:734-753-4845
Mailing Address - Fax:
Practice Address - Street 1:32530 PRESCOTT ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-9718
Practice Address - Country:US
Practice Address - Phone:734-753-4845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI397619-00OtherNATIONAL CERTIFICATION