Healthcare Provider Details

I. General information

NPI: 1902792880
Provider Name (Legal Business Name): NEW LIFESTYLE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 ANASTASIA BLVD UNIT A
ST AUGUSTINE FL
32080-4618
US

IV. Provider business mailing address

3979 MEADOWVIEW DR N
JACKSONVILLE FL
32225-1694
US

V. Phone/Fax

Practice location:
  • Phone: 904-755-5068
  • Fax:
Mailing address:
  • Phone: 904-755-5068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JIANG LI
Title or Position: OWNER
Credential: LMT
Phone: 904-755-5068