Healthcare Provider Details

I. General information

NPI: 1457275695
Provider Name (Legal Business Name): MYOBALANCE CLINICAL MASSAGE AND MANUAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 N CHERRY ST
MONTICELLO FL
32344-1925
US

IV. Provider business mailing address

260 N CHERRY ST
MONTICELLO FL
32344-1925
US

V. Phone/Fax

Practice location:
  • Phone: 448-242-4103
  • Fax:
Mailing address:
  • Phone: 448-242-4103
  • Fax: 850-360-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. CHANTAL CALAIS
Title or Position: FOUNDER / MANAGING MEMBER
Credential: MT
Phone: 850-320-1122