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General NPI Number Information
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NPI Number | 1083622161
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Entity Type | Organization
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Legal Business Name | TLC MASSAGE, INC
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2072 S MILITARY TRL SUITE 7
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City | WEST PALM BEACH
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State | FL
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Zip | 33415-6419
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Country | US
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Telephone | 561-965-5500
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Fax | 561-965-5592
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Provider Business Mailing Address
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Address Line | 2774 POINTE CIR
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City | GREENACRES
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State | FL
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Zip | 33413-2153
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Country | US
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Telephone | 561-439-3262
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Fax |
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Authorized Official
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Title or Position | LICENSE MASSAGE THERAPIST
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Name | NELLIE ESTHER RENDON
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Credential | LMT
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Telephone | 561-965-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA0012117
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License Number State | FL
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