Provider Demographics
NPI:1902170178
Name:KORMANIK, JENNIE JERMAN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:JERMAN
Last Name:KORMANIK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2082 STABLER RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6040
Mailing Address - Country:US
Mailing Address - Phone:330-860-4836
Mailing Address - Fax:
Practice Address - Street 1:104 3RD ST NW
Practice Address - Street 2:#103
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-8223
Practice Address - Country:US
Practice Address - Phone:330-848-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.020108225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist