Healthcare Provider Details

I. General information

NPI: 1760617278
Provider Name (Legal Business Name): TREE OF LIFE MASSAGE AND BODY WORKS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 COMMERCIAL WAY
SPRING HILL FL
34606-2325
US

IV. Provider business mailing address

4337 COMMERCIAL WAY PMB 111
SPRING HILL FL
34606-3319
US

V. Phone/Fax

Practice location:
  • Phone: 352-684-6424
  • Fax: 352-684-6423
Mailing address:
  • Phone: 352-684-6424
  • Fax: 352-684-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number194
License Number StateFL

VIII. Authorized Official

Name: MR. MARIO ANZALONE
Title or Position: OWNER/LMT
Credential:
Phone: 352-684-6424