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General NPI Number Information
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NPI Number | 1477421873
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Entity Type | Organization
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Legal Business Name | INTEGRATED WELLNESS MASSAGE LLC
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 220 RIVERSIDE AVE STE 114-205
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City | JACKSONVILLE
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State | FL
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Zip | 32202-4964
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Country | US
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Telephone | 904-758-8568
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Fax |
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Provider Business Mailing Address
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Address Line | 4320 DEERWOOD LAKE PKWY STE 101-107
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City | JACKSONVILLE
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State | FL
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Zip | 32216-1177
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LMT/MANAGER
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Name | LAUREN CREECH
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Credential | LMT
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Telephone | 904-758-8568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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