Provider Demographics
NPI:1306851712
Name:KOHRN, JAMIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:KOHRN
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 1:6929 ALANA RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-4176
Mailing Address - Country:US
Mailing Address - Phone:904-891-2459
Mailing Address - Fax:904-551-7042
Practice Address - Street 1:6929 ALANA RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-4176
Practice Address - Country:US
Practice Address - Phone:904-891-2459
Practice Address - Fax:904-551-7042
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0007452225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC5115OtherBCBSFL PROVIDER #