Individual
KELLY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1325 SAN MARCO BLVD, SUITE 102, JACKSONVILLE, FL 32207-8568
(904) 858-7045
Mailing address
1325 SAN MARCO BLVD, SUITE 102, JACKSONVILLE, FL 32207-8568
(904) 858-7045
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA61239
FL
Other
Enumeration date
07/15/2016
Last updated
07/15/2016
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