Provider Demographics
NPI:1962838789
Name:TURNER, JERILYN TRENISE (MT)
Entity Type:Individual
Prefix:
First Name:JERILYN
Middle Name:TRENISE
Last Name:TURNER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 OMEGA DR
Mailing Address - Street 2:STE 202
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2075
Mailing Address - Country:US
Mailing Address - Phone:817-472-7700
Mailing Address - Fax:
Practice Address - Street 1:601 OMEGA DR
Practice Address - Street 2:STE 202
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2075
Practice Address - Country:US
Practice Address - Phone:817-472-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT114780225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist