Individual
JEREMIAH KENDALE MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16410 S 12TH ST APT 213, PHOENIX, AZ 85048-4007
(480) 765-0367
Mailing address
16410 S 12TH ST APT 213, PHOENIX, AZ 85048-4007
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-25692
AZ
Other
Enumeration date
12/21/2020
Last updated
12/21/2020
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