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General NPI Number Information
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NPI Number | 1548462864
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Entity Type | Organization
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Legal Business Name | JACKSONVILLE MEDICAL & WELLNESS MASSAGE, INC.
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7545 CENTURION PKWY SUITE 304
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0579
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Country | US
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Telephone | 904-645-8850
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Fax | 904-645-8865
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Provider Business Mailing Address
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Address Line | 7545 CENTURION PKWY SUITE 304
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0579
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Country | US
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Telephone | 904-645-8850
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Fax | 904-645-8865
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS JESSICA K ADAMS
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Credential | L.M.T., N.C.M.M.T.
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Telephone | 904-645-8850
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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 | MM18737
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License Number State | FL
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