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NPI Code Detail

MEDICARE: MICHAELA KILEY CORNMAN LMT

MEDICARE: MICHAELA KILEY CORNMAN 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 TherapistMA60619FL

General Provider Information

NPI Number : 1356191811
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAELA KILEY CORNMAN LMT
Provider Business Mailing Address
First Line : 9785 CROSSHILL BLVD STE 108
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32222-5889
Country : US
Telephone Number : 904-626-2689
Fax Number :
Provider Business Practice Location Address
First Line : 9785 CROSSHILL BLVD STE 108
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32222-5889
Country : US
Telephone Number : 904-772-6522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2024
Last Update Date : 03/26/2024

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Directions to “ MICHAELA KILEY CORNMAN LMT” Practice Location

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