Provider Demographics
NPI:1720354772
Name:JOHNS, JENNIFER LYNN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:JOHNS
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 1:807 MILLEDGEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HADLEY
Mailing Address - State:PA
Mailing Address - Zip Code:16130-1219
Mailing Address - Country:US
Mailing Address - Phone:412-980-8221
Mailing Address - Fax:
Practice Address - Street 1:807 MILLEDGEVILLE RD
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:PA
Practice Address - Zip Code:16130-1219
Practice Address - Country:US
Practice Address - Phone:412-980-8221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG002323225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist