Individual
JESSE FERRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
4700 N CENTRAL AVE, SUITE 116, PHOENIX, AZ 85012-1719
(602) 573-1309
Mailing address
44 W MONROE ST, # 1401, PHOENIX, AZ 85003-4553
(602) 573-1309
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-04127P
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MTY-04127P
MASSAGE THERAPY LICENSE
AZ
Enumeration date
03/16/2012
Last updated
03/16/2012
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