Healthcare Provider Details

I. General information

NPI: 1356254940
Provider Name (Legal Business Name): THIRD GENERATION MASSAGE AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 W DEARBORN ST STE C
ENGLEWOOD FL
34223-3167
US

IV. Provider business mailing address

6023 SUNNYBROOK BLVD
ENGLEWOOD FL
34224-8260
US

V. Phone/Fax

Practice location:
  • Phone: 941-544-0528
  • Fax:
Mailing address:
  • Phone: 941-544-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: SIERRA POWELL
Title or Position: PRINCIPAL / OWNER
Credential:
Phone: 941-544-0528