Provider Demographics
NPI:1902048598
Name:GOOSSEN, SHANNON PAGE (AP, LMT)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:PAGE
Last Name:GOOSSEN
Suffix:
Gender:F
Credentials:AP, LMT
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Mailing Address - Street 1:14546 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5468
Mailing Address - Country:US
Mailing Address - Phone:904-296-1500
Mailing Address - Fax:904-391-1005
Practice Address - Street 1:14546 OLD ST AUGUSTINE ROAD
Practice Address - Street 2:SUITE 403
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258
Practice Address - Country:US
Practice Address - Phone:904-296-1500
Practice Address - Fax:904-391-1005
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAP 1566171100000X
FLMA 20767225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist