=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548159601
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THANAWAN SRIRATCHAYA ASKANDER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2025
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2467 FAYE RD STE 4
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32226-2098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-518-4555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4500 BAYMEADOWS RD APT 49
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32217-5104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-215-3623
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA107557
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------