Individual
MR. JACOB JON HENNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT MA
Contact information
Practice address
3543 N 7 ST, PHOENIX, AZ 85014
(602) 263-8484
(602) 263-3697
Mailing address
5638 W GLENROSA, PHOENIX, AZ 85031
(623) 247-9621
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT04134
AZ
Other
Enumeration date
03/05/2007
Last updated
07/08/2007
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