Provider Demographics
NPI:1578287512
Name:NEWTON, JENNIFER (LMT, CCT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:NEWTON
Suffix:
Gender:F
Credentials:LMT, CCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 E BLACKLIDGE DR APT 111
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1448
Mailing Address - Country:US
Mailing Address - Phone:417-629-2728
Mailing Address - Fax:
Practice Address - Street 1:1643 N ALVERNON WAY STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3350
Practice Address - Country:US
Practice Address - Phone:520-230-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-26506225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist