Provider Demographics
NPI:1295425643
Name:AGUINALDO, JENSEN (LMT)
Entity type:Individual
Prefix:MR
First Name:JENSEN
Middle Name:
Last Name:AGUINALDO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5798 OGEECHEE RD APT 124
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-9532
Mailing Address - Country:US
Mailing Address - Phone:808-258-5492
Mailing Address - Fax:
Practice Address - Street 1:836 E 65TH ST STE 20
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4493
Practice Address - Country:US
Practice Address - Phone:808-258-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013537225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist