Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA52451 | FL |
NPI | 1003191784 |
---|---|
Provider Name | Michiko Jardine |
First Address | Jacksonville, FL 32223-2669 |
Second Address | Jacksonville, FL 32223-2669 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2011 |
Last Update Date | 13/10/2011 |