Provider Demographics
NPI:1518549989
Name:BELL, GEORGIENNE (LMT)
Entity type:Individual
Prefix:
First Name:GEORGIENNE
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 TREMOLINO WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7358
Mailing Address - Country:US
Mailing Address - Phone:813-215-7690
Mailing Address - Fax:
Practice Address - Street 1:9889 GATE PKWY N STE 305
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-9230
Practice Address - Country:US
Practice Address - Phone:904-513-3954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA93666225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist