Provider Demographics
NPI:1700377017
Name:BOSSIE, JASMINE (LMT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:BOSSIE
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 1:11100 PINION CT
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2565
Mailing Address - Country:US
Mailing Address - Phone:301-787-3192
Mailing Address - Fax:
Practice Address - Street 1:11100 PINION CT
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2565
Practice Address - Country:US
Practice Address - Phone:301-787-3192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05925225700000X
DCMT2389225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM05925OtherMD MASSAGE LICENSE
DCMT2389OtherDC MASSAGE LICENSE