Individual
GINA WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
13241 BARTRAM PARK BLVD, SUITE 513, JACKSONVILLE, FL 32258-5212
(904) 610-4462
Mailing address
11311 CHERTSEY LN, JACKSONVILLE, FL 32223-8775
(904) 610-4462
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA29301
FL
Other
Enumeration date
06/21/2010
Last updated
02/18/2011
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