MEDICARE: TRINA WISE HENKEL 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	MA37838	FL

General Provider Information

NPI Number	:	1265699318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRINA WISE HENKEL LMT

Provider Business Mailing Address
First Line	:	6800 NW MONOCO CT
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-5376
Country	:	US
Telephone Number	:	772-812-9953
Fax Number	:	772-871-7842

Provider Business Practice Location Address
First Line	:	1001 W MIDWAY RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-4142
Country	:	US
Telephone Number	:	772-812-9953
Fax Number	:	772-871-7842

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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