Healthcare Provider Details

I. General information

NPI: 1164229779
Provider Name (Legal Business Name): CHINA KAPRI JOLLY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2025
Last Update Date: 03/01/2025
Certification Date: 03/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 LEWIS SPEEDWAY UNIT 101
ST AUGUSTINE FL
32084-8669
US

IV. Provider business mailing address

45 WELLHAM LN UNIT A
PALM COAST FL
32164-8004
US

V. Phone/Fax

Practice location:
  • Phone: 470-844-2078
  • Fax:
Mailing address:
  • Phone: 470-844-2078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA98786
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: