NPIMap

Organization Active NPI

Comprehensive Myofascial Therapy Associates, PA

  • Physical Therapist
  • Jacksonville, FL
National Provider Identifier
1174765903
Registry record updated Mar 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 6380 Issued in FL
Legal business name
COMPREHENSIVE MYOFASCIAL THERAPY ASSOCIATES, PA
Practice address
14546 Old Saint Augustine Rd
Suite 403
Jacksonville, FL 32258-5468
Phone
(904) 296-1500
Fax
(904) 391-1005
NPI assigned
Mar 25, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Shannon Page Goossen, AP, LMT
Title
President
Phone
(904) 296-1500

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
AcupuncturistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 171100000X AP1566 FL
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X PT 6380 FL Primary
Massage TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225700000X MA 20767 FL

Addresses

Primary practice location

14546 Old Saint Augustine Rd
Suite 403
Jacksonville, FL 32258-5468

Mailing address

14546 Old Saint Augustine Rd
Suite 403
Jacksonville, FL 32258-5468
Phone (904) 296-1500

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237939200000",
    "number": "1174765903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14546 OLD SAINT AUGUSTINE RD",
            "address_2": "SUITE 403",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585468",
            "telephone_number": "904-296-1500",
            "fax_number": "904-391-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14546 OLD SAINT AUGUSTINE RD",
            "address_2": "SUITE 403",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585468",
            "telephone_number": "904-296-1500",
            "fax_number": "904-391-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE MYOFASCIAL THERAPY ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-25",
        "last_updated": "2009-03-25",
        "status": "A",
        "authorized_official_last_name": "GOOSSEN",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "PAGE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-296-1500",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "AP, LMT"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "FL",
            "license": "AP1566",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 6380",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA 20767",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.