Provider Demographics
NPI:1144915000
Name:PRIDGEN, JIAN (LMT)
Entity type:Individual
Prefix:
First Name:JIAN
Middle Name:
Last Name:PRIDGEN
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 1:405 E WETMORE RD # 117-190
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1717
Mailing Address - Country:US
Mailing Address - Phone:919-523-1767
Mailing Address - Fax:
Practice Address - Street 1:3000 W VALENCIA RD STE 238
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-8059
Practice Address - Country:US
Practice Address - Phone:520-369-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-28209225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist