Provider Demographics
NPI:1811020985
Name:SHEVITZ, JENNIFER SAX (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SAX
Last Name:SHEVITZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11724 54TH DR SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9132
Mailing Address - Country:US
Mailing Address - Phone:206-795-2982
Mailing Address - Fax:
Practice Address - Street 1:12322 HIGHWAY 99 STE 96
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-8548
Practice Address - Country:US
Practice Address - Phone:206-795-2982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015839225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist