Provider Demographics
NPI:1043468705
Name:THUNBERG, JILL CHRISTIAN (LMT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CHRISTIAN
Last Name:THUNBERG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:CHRISTIAN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2320 3RD ST S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JAX BCH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4058
Mailing Address - Country:US
Mailing Address - Phone:904-962-3509
Mailing Address - Fax:
Practice Address - Street 1:2320 3RD ST S
Practice Address - Street 2:SUITE 1
Practice Address - City:JAX BCH
Practice Address - State:FL
Practice Address - Zip Code:32250-4058
Practice Address - Country:US
Practice Address - Phone:904-962-3509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA28064225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist