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General NPI Number Information
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NPI Number | 1124371380
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Entity Type | Organization
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Legal Business Name | NORTH RIVER BODY THERAPIES
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Dates
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Enumeration Date | 10/24/2012
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 1415 10TH ST E
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City | PALMETTO
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State | FL
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Zip | 34221-4278
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Country | US
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Telephone | 941-721-4559
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Fax | 941-721-0142
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Provider Business Mailing Address
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Address Line | 1415 10TH ST E
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City | PALMETTO
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State | FL
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Zip | 34221-4278
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Country | US
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Telephone | 941-721-4559
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Fax | 941-721-0142
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE ANN DEITRICK
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Credential | LMT
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Telephone | 941-721-4559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MM10209
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License Number State | FL
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