Organization
COMPREHENSIVE MYOFASCIAL THERAPY ASSOCIATES, PA
Active
Organization
COMPREHENSIVE MYOFASCIAL THERAPY ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANNON PAGE GOOSSEN AP, LMT (PRESIDENT)
(904) 296-1500
Entity
Organization
Contact information
Practice address
14546 OLD SAINT AUGUSTINE RD, SUITE 403, JACKSONVILLE, FL 32258-5468
(904) 296-1500
(904) 391-1005
Mailing address
14546 OLD SAINT AUGUSTINE RD, SUITE 403, JACKSONVILLE, FL 32258-5468
(904) 296-1500
(904) 391-1005
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
AP1566
FL
225100000X
Physical Therapist
Primary
PT 6380
FL
225700000X
Massage Therapist
MA 20767
FL
Other
Enumeration date
03/25/2009
Last updated
03/25/2009
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