Healthcare Provider Details

I. General information

NPI: 1780593368
Provider Name (Legal Business Name): TRACI LYNN MCHENAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 LUNA BELLA LN APT 330
NEW SMYRNA BEACH FL
32168-4522
US

IV. Provider business mailing address

434 LUNA BELLA LN APT 330
NEW SMYRNA BEACH FL
32168-4522
US

V. Phone/Fax

Practice location:
  • Phone: 207-669-5222
  • Fax:
Mailing address:
  • Phone: 207-669-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA106739
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: