MEDICARE: JULIA E EVERSON

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	MM64596	FL

General Provider Information

NPI Number	:	1134678584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA E EVERSON

Provider Business Mailing Address
First Line	:	1715 HODGES BLVD APT 2308
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-1086
Country	:	US
Telephone Number	:	904-250-3964
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 3RD ST S STE 12
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-4057
Country	:	US
Telephone Number	:	904-881-8080
Fax Number	:

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

Provider Enumeration Date	:	09/27/2016
Last Update Date	:	09/27/2016

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Directions to “ JULIA E EVERSON ” Practice Location

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