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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