Individual
JESSICA DALLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
208 SOUTHPARK CIR E, ST AUGUSTINE, FL 32086-5135
(904) 823-8833
(904) 823-9394
Mailing address
208 SOUTHPARK CIR E, ST AUGUSTINE, FL 32086-5135
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA36374
FL
Other
Enumeration date
05/18/2010
Last updated
05/18/2010
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