Individual
JENNIFER LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
5211 HIGHWAY 153 STE D, HIXSON, TN 37343-4957
(423) 875-9797
Mailing address
5211 HWY 153 STE D, HIXSON, TN 37343
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT0000009393
TN
Other
Enumeration date
01/03/2013
Last updated
01/03/2013
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