Provider Demographics
NPI:1841434230
Name:GRIESHABER, JENNIFER ROSE (CMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:GRIESHABER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10275 HENDERSON HALL RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-5135
Mailing Address - Country:US
Mailing Address - Phone:804-368-0341
Mailing Address - Fax:
Practice Address - Street 1:10275 HENDERSON HALL RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-5135
Practice Address - Country:US
Practice Address - Phone:804-368-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006794225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist