Provider Demographics
NPI:1750933529
Name:TOON, JAMES BRADLEY (LMT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRADLEY
Last Name:TOON
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 1:4063 LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8928
Mailing Address - Country:US
Mailing Address - Phone:904-718-2942
Mailing Address - Fax:
Practice Address - Street 1:12443 SAN JOSE BLVD STE 801
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8654
Practice Address - Country:US
Practice Address - Phone:904-718-2942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52310225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist