Provider Demographics
NPI:1760154132
Name:STANDLEY, JESSICA ANN (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:STANDLEY
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 E 7TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-4966
Mailing Address - Country:US
Mailing Address - Phone:512-412-5772
Mailing Address - Fax:
Practice Address - Street 1:821 E 7TH ST APT 4
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-4966
Practice Address - Country:US
Practice Address - Phone:512-412-5772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0021936225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist