Individual
LISA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, PT, AS, CHHC
Contact information
Practice address
7200 SW 8TH AVE APT 9, GAINESVILLE, FL 32607-1883
(352) 222-5381
Mailing address
7200 SW 8TH AVE # B-9, GAINESVILLE, FL 32607-1888
(352) 222-5381
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA45132
FL
Other
Enumeration date
05/13/2010
Last updated
11/23/2011
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