Provider Demographics
NPI:1790445815
Name:MYNETT, DAVID (LMT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:MYNETT
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-2122
Mailing Address - Country:US
Mailing Address - Phone:904-654-7982
Mailing Address - Fax:
Practice Address - Street 1:2657 SENECA DR
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-2122
Practice Address - Country:US
Practice Address - Phone:904-654-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63766225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist