Basic Information
Provider Information
NPI: 1376035816
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BIERBOWER
FirstName: JENNIFER
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: LMT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2108 HARRISBURG PIKE STE 315
Address2:  
City: LANCASTER
State: PA
PostalCode: 176012644
CountryCode: US
TelephoneNumber: 7175443555
FaxNumber: 7175443560
Practice Location
Address1: 690 GOOD DR
Address2:  
City: LANCASTER
State: PA
PostalCode: 176012433
CountryCode: US
TelephoneNumber: 7175440700
FaxNumber: 7175440729
Other Information
ProviderEnumerationDate: 05/31/2018
LastUpdateDate: 10/25/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225700000XMSG009767PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist 

No ID Information.


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