Provider Demographics
NPI:1760499107
Name:SOMMERMANN, JENNIFER (LCMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SOMMERMANN
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5731
Mailing Address - Country:US
Mailing Address - Phone:516-633-9464
Mailing Address - Fax:
Practice Address - Street 1:67 E 2ND ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5731
Practice Address - Country:US
Practice Address - Phone:516-633-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015875-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist