Provider Demographics
NPI:1578317764
Name:REVERIE, JESSICA FRANCES (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:FRANCES
Last Name:REVERIE
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 1:21 S IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-2509
Mailing Address - Country:US
Mailing Address - Phone:484-788-8582
Mailing Address - Fax:
Practice Address - Street 1:21 S IDAHO ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-2509
Practice Address - Country:US
Practice Address - Phone:484-788-8582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-8058225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist