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NPI Code Detail

MEDICARE: JACKIE LYNN WALSINGHAM LMT

MEDICARE: JACKIE LYNN WALSINGHAM LMT
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
1225700000XMassage TherapistMA52150FL

General Provider Information

NPI Number : 1942472162
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKIE LYNN WALSINGHAM LMT
Provider Business Mailing Address
First Line : 315 E ASH ST
Second Line :
City : PERRY
State : FL
Zip : 32347-2029
Country : US
Telephone Number : 850-584-3278
Fax Number : 850-584-8171
Provider Business Practice Location Address
First Line : 315 E ASH ST
Second Line :
City : PERRY
State : FL
Zip : 32347-2029
Country : US
Telephone Number : 850-584-3278
Fax Number : 850-584-8171
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2008
Last Update Date : 03/27/2008

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Directions to “ JACKIE LYNN WALSINGHAM LMT” Practice Location

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