Provider Demographics
NPI:1528955929
Name:LAWSTON, IZABELLE (LMT)
Entity type:Individual
Prefix:
First Name:IZABELLE
Middle Name:
Last Name:LAWSTON
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 1:1555 ROSEBERRY CT
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-6305
Mailing Address - Country:US
Mailing Address - Phone:503-719-0981
Mailing Address - Fax:
Practice Address - Street 1:1628 SAN MARCO BLVD STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-3066
Practice Address - Country:US
Practice Address - Phone:503-719-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA107172225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty