Provider Demographics
NPI:1689001950
Name:RECKOW, JANE LORIE (CMT)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:LORIE
Last Name:RECKOW
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 24TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2521
Mailing Address - Country:US
Mailing Address - Phone:320-493-8494
Mailing Address - Fax:
Practice Address - Street 1:600 25TH AVE S
Practice Address - Street 2:SUITE # 210
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4866
Practice Address - Country:US
Practice Address - Phone:320-493-8494
Practice Address - Fax:320-253-4248
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist