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General NPI Number Information
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NPI Number | 1114437944
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Entity Type | Organization
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Legal Business Name | FIVE POINTS THERAPEUTIC MASSAGE
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 1012 MARGARET ST STE 102
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3737
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Country | US
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Telephone | 904-235-8104
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 BRIAN LAKES DR E
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City | JACKSONVILLE
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State | FL
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Zip | 32221-2836
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Country | US
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Telephone | 904-235-8104
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DARA LIZABETH GRANADOS
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Credential | LMT
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Telephone | 904-235-8104
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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 | MA53901
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License Number State | FL
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