Provider Demographics
NPI:1548462864
Name:JACKSONVILLE MEDICAL & WELLNESS MASSAGE, INC.
Entity type:Organization
Organization Name:JACKSONVILLE MEDICAL & WELLNESS MASSAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NCMMT
Authorized Official - Phone:904-645-8850
Mailing Address - Street 1:7545 CENTURION PKWY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0579
Mailing Address - Country:US
Mailing Address - Phone:904-645-8850
Mailing Address - Fax:904-645-8865
Practice Address - Street 1:7545 CENTURION PKWY
Practice Address - Street 2:SUITE 304
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0579
Practice Address - Country:US
Practice Address - Phone:904-645-8850
Practice Address - Fax:904-645-8865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM18737225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty