Healthcare Provider Details

I. General information

NPI: 1205742301
Provider Name (Legal Business Name): TRICIA RACQUEL MARSHALL LMBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WEAVERVILLE RD STE 201
WOODFIN NC
28804-1388
US

IV. Provider business mailing address

1045 CIDER MILL LOOP APT 304
WEAVERVILLE NC
28787-1567
US

V. Phone/Fax

Practice location:
  • Phone: 850-760-4958
  • Fax:
Mailing address:
  • Phone: 850-760-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23267
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: