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General NPI Number Information
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NPI Number | 1124873120
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIVE TREK THERAPY LLC
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 6451 SE 180TH AVE
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City | MORRISTON
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State | FL
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Zip | 32668-5257
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Country | US
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Telephone | 352-316-7204
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Fax |
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Provider Business Mailing Address
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Address Line | 21 HOLLY BERRY RD
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City | FREDERICKSBURG
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State | VA
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Zip | 22406-5340
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Country | US
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Telephone | 352-316-7204
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PAIGE ASHLEY MARKHAM UEBELE
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Credential |
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Telephone | 352-316-7204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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