Healthcare Provider Details

I. General information

NPI: 1699900597
Provider Name (Legal Business Name): CHRISTINE C. GATZKE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 PARK ST
JACKSONVILLE FL
32204-3809
US

IV. Provider business mailing address

2025 PARK ST
JACKSONVILLE FL
32204-3809
US

V. Phone/Fax

Practice location:
  • Phone: 904-388-1811
  • Fax: 904-387-6091
Mailing address:
  • Phone: 904-388-1811
  • Fax: 904-387-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA45850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: