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Individual

MELISSA LIVIA DEVLIN JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
2200 N PONCE DE LEON BLVD, SUITE 5, SAINT AUGUSTINE, FL 32084-2600
(904) 377-5343
Mailing address
2200 N PONCE DE LEON BLVD, SUITE 5, SAINT AUGUSTINE, FL 32084-2600
(904) 377-5343

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA26832
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C2974
BCBS
FL
Enumeration date
09/07/2011
Last updated
09/07/2011
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