Healthcare Provider Details

I. General information

NPI: 1952419848
Provider Name (Legal Business Name): A NEW U INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 SAINT JOHNS AVE SUITE 4
JACKSONVILLE FL
32210-1848
US

IV. Provider business mailing address

4570 SAINT JOHNS AVE SUITE 4
JACKSONVILLE FL
32210-1848
US

V. Phone/Fax

Practice location:
  • Phone: 904-389-0030
  • Fax: 904-389-5511
Mailing address:
  • Phone: 904-389-0030
  • Fax: 904-389-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA31726
License Number StateFL

VIII. Authorized Official

Name: KIMBERLY SANDERS REAVES
Title or Position: OWNER
Credential: LMT
Phone: 904-389-0030