Healthcare Provider Details

I. General information

NPI: 1659203222
Provider Name (Legal Business Name): JESSIE COLSTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FANG CAO

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 24TH ST
VERO BEACH FL
32960-3351
US

IV. Provider business mailing address

515 WRIGHT CIR
VERO BEACH FL
32968-9644
US

V. Phone/Fax

Practice location:
  • Phone: 561-701-4789
  • Fax:
Mailing address:
  • Phone: 561-701-4789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA99838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: