Provider Demographics
NPI:1649287244
Name:ABBOTT, JAMES L (LMT, NCTMB)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 REMLER DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2771
Mailing Address - Country:US
Mailing Address - Phone:904-705-5220
Mailing Address - Fax:
Practice Address - Street 1:9825 SAN JOSE BLVD STE 27
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5489
Practice Address - Country:US
Practice Address - Phone:904-705-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA28802225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist