Healthcare Provider Details

I. General information

NPI: 1649287244
Provider Name (Legal Business Name): JAMES L ABBOTT LMT, NCTMB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9825 SAN JOSE BLVD STE 27
JACKSONVILLE FL
32257-5489
US

IV. Provider business mailing address

3261 REMLER DR S
JACKSONVILLE FL
32223-2771
US

V. Phone/Fax

Practice location:
  • Phone: 904-705-5220
  • Fax:
Mailing address:
  • Phone: 904-705-5220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA28802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: