Healthcare Provider Details

I. General information

NPI: 1932475043
Provider Name (Legal Business Name): THE LEE TRITT WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 03/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 PORT MALABAR BLVD NE SUITE 106
PALM BAY FL
32905-5161
US

IV. Provider business mailing address

1071 PORT MALABAR BLVD NE SUITE 106
PALM BAY FL
32905-5161
US

V. Phone/Fax

Practice location:
  • Phone: 321-676-3383
  • Fax: 321-676-3384
Mailing address:
  • Phone: 321-676-3383
  • Fax: 321-676-3384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ADAM BYRN TRITT
Title or Position: OWNER
Credential: M.ED, LMT
Phone: 321-676-3383