Healthcare Provider Details

I. General information

NPI: 1083535256
Provider Name (Legal Business Name): IAROSLAV DUMIAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9785 CROSSHILL BLVD STE 108
JACKSONVILLE FL
32222-5889
US

IV. Provider business mailing address

9785 CROSSHILL BLVD STE 108
JACKSONVILLE FL
32222-5889
US

V. Phone/Fax

Practice location:
  • Phone: 904-772-6522
  • Fax: 904-772-6553
Mailing address:
  • Phone: 904-772-6522
  • Fax: 904-772-6553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA109141
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: