MEDICARE: ROSELYN ROSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA39026	FL

General Provider Information

NPI Number	:	1164696472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSELYN ROSS

Provider Business Mailing Address
First Line	:	PO BOX 19133
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32245-9133
Country	:	US
Telephone Number	:	904-805-9075
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2946
Country	:	US
Telephone Number	:	904-566-1686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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Directions to “ ROSELYN ROSS ” Practice Location

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