Provider Demographics
NPI:1366800492
Name:THOMAS, DAWN (LMT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:THOMAS
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 1:578 MADEIRA DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4331
Mailing Address - Country:US
Mailing Address - Phone:904-504-7245
Mailing Address - Fax:
Practice Address - Street 1:12058 SAN JOSE BLVD STE 703
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8668
Practice Address - Country:US
Practice Address - Phone:904-260-0454
Practice Address - Fax:904-260-0044
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46798225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist