Individual
MRS. MARY VICTORIA JETMORE-REICHARDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MP
Contact information
Practice address
580 FOREST SHADE #4, CRESTLINE, CA 92325
(909) 338-6477
Mailing address
PO BOX 6493, 22652 WATERS DRIVE, CRESTLINE, CA 92325-6493
(916) 201-3908
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
10826
CA
Other
Enumeration date
01/25/2011
Last updated
01/25/2011
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