Provider Demographics
NPI:1255757514
Name:FOX, JENNIFER (LMT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:FOX
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 1:1700 S HIGHWAY 92 STE E-2
Mailing Address - Street 2:BODY WISE
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5856
Mailing Address - Country:US
Mailing Address - Phone:520-559-0785
Mailing Address - Fax:
Practice Address - Street 1:5151 E. HWY 90
Practice Address - Street 2:COCHISE ONCOLOGY
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-5856
Practice Address - Country:US
Practice Address - Phone:520-458-1187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-07226P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist