Individual
JENNIFER TIETSORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
632 MOUNT RUSHMORE RD, CUSTER, SD 57730-2031
(605) 440-0126
Mailing address
632 MOUNT RUSHMORE RD, CUSTER, SD 57730-2031
(605) 440-0126
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT10058
SD
Other
Enumeration date
07/12/2015
Last updated
07/12/2015
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