MEDICARE: JILL CHRISTIAN THUNBERG 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
1	225700000X	Massage Therapist	MA28064	FL

General Provider Information

NPI Number	:	1043468705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL CHRISTIAN THUNBERG LMT

Provider Business Mailing Address
First Line	:	2320 3RD ST S
Second Line	:	SUITE 1
City	:	JAX BCH
State	:	FL
Zip	:	32250-4058
Country	:	US
Telephone Number	:	904-962-3509
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 3RD ST S
Second Line	:	SUITE 1
City	:	JAX BCH
State	:	FL
Zip	:	32250-4058
Country	:	US
Telephone Number	:	904-962-3509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	09/05/2008

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