Provider Demographics
NPI:1982003463
Name:BRITTON, JESSICA ANNETTE (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNETTE
Last Name:BRITTON
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 1:1950 BLUEGRASS CIR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7323
Mailing Address - Country:US
Mailing Address - Phone:307-514-5964
Mailing Address - Fax:307-514-5966
Practice Address - Street 1:1950 BLUEGRASS CIR
Practice Address - Street 2:SUITE 110
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7323
Practice Address - Country:US
Practice Address - Phone:307-514-5964
Practice Address - Fax:307-514-5966
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYOL-15-29720225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist