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NPI Code Detail

MEDICARE: MICHIKO JARDINE LMT

MEDICARE: MICHIKO JARDINE LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMA52451FL

General Provider Information

NPI Number : 1003191784
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHIKO JARDINE LMT
Provider Business Mailing Address
First Line : 12795 SAN JOSE BLVD
Second Line : SUITE 9
City : JACKSONVILLE
State : FL
Zip : 32223-2669
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12795 SAN JOSE BLVD
Second Line : SUITE 9
City : JACKSONVILLE
State : FL
Zip : 32223-2669
Country : US
Telephone Number : 904-619-1587
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2011
Last Update Date : 10/13/2011

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Directions to “ MICHIKO JARDINE LMT” Practice Location

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