MEDICARE: CRYSTAL MACK MASSAGE THERAPIST

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	MA102294	FL

General Provider Information

NPI Number	:	1942148747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MACK MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	3450 DUNN AVE STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-6427
Country	:	US
Telephone Number	:	904-418-4611
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 DUNN AVE STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-6427
Country	:	US
Telephone Number	:	904-418-4611
Fax Number	:

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

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ CRYSTAL MACK MASSAGE THERAPIST” Practice Location

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