Provider Demographics
NPI:1457769283
Name:MASSAGE BY JENNI, LLC
Entity Type:Organization
Organization Name:MASSAGE BY JENNI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNI
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:801-879-4173
Mailing Address - Street 1:185 E HANDCART WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-0360
Mailing Address - Country:US
Mailing Address - Phone:801-879-4173
Mailing Address - Fax:
Practice Address - Street 1:1174 E GRAYSTONE WAY
Practice Address - Street 2:SUITE #18
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2673
Practice Address - Country:US
Practice Address - Phone:801-879-4173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4828370-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty