Provider Demographics
NPI:1326118050
Name:SAVAGE, JACKIE MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:MARIE
Last Name:SAVAGE
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:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32178-0217
Mailing Address - Country:US
Mailing Address - Phone:386-530-0137
Mailing Address - Fax:
Practice Address - Street 1:120 S PALM AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4140
Practice Address - Country:US
Practice Address - Phone:386-937-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43020225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2905OtherBLUE CROSS BLUE SHIELD OF