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General NPI Number Information
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NPI Number | 1083376172
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Entity Type | Individual
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Provider Name | JINGYAO ZHENG LAT,ATC, LMT
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Gender | Male
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 3351 HENDRICKS AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32207-5301
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Country | US
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Telephone | 904-402-4399
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Fax |
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Provider Business Mailing Address
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Address Line | 5420 TURKEY CREEK CT
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City | JACKSONVILLE
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State | FL
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Zip | 32244-8550
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Country | US
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Telephone | 904-868-8118
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA94716
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL4532
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License Number State | FL
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