MEDICARE: TREVIA NYREE DANIELS LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	44078	FL

General Provider Information

NPI Number	:	1215543863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVIA NYREE DANIELS LMT

Provider Business Mailing Address
First Line	:	PO BOX 1616
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33601-1616
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5212 BON VIVANT DR APT 38
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1842
Country	:	US
Telephone Number	:	813-298-5136
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2020
Last Update Date	:	09/18/2020

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