Organization
GENESIS BODYWORK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMY LOUISE LAGASSE P.T.A., L.M.T. (OWNER)
(904) 471-2999
Entity
Organization
Contact information
Practice address
4075 A1A S, SUITE 105, ST AUGUSTINE, FL 32080-6773
(904) 471-2999
(904) 471-1722
Mailing address
4075 A1A S, SUITE 105, ST AUGUSTINE, FL 32080-6773
(904) 471-2999
(904) 471-1722
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
03/15/2007
Last updated
02/02/2012
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