Provider Demographics
NPI:1982337036
Name:SPROCK, JENNIFER LOVE (NMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOVE
Last Name:SPROCK
Suffix:
Gender:F
Credentials:NMT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LOVE
Other - Last Name:STRINGFELLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2164 ATRISCO CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-2736
Mailing Address - Country:US
Mailing Address - Phone:916-827-5766
Mailing Address - Fax:
Practice Address - Street 1:1122 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-6124
Practice Address - Country:US
Practice Address - Phone:916-395-5804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72737225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist