Healthcare Provider Details

I. General information

NPI: 1568376168
Provider Name (Legal Business Name): KIRSTAN ALLI MCCARTHY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 BALMORAL CIR N STE 305
JACKSONVILLE FL
32218-5583
US

IV. Provider business mailing address

13638 MAJESTIC CT
JACKSONVILLE FL
32218-2864
US

V. Phone/Fax

Practice location:
  • Phone: 904-909-2120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number110244
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: