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General NPI Number Information
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NPI Number | 1265323711
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Entity Type | Organization
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Legal Business Name | PEACE RIVER TCM LLC
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 230 BURNEY RD
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City | OSPREY
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State | FL
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Zip | 34229-9444
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Country | US
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Telephone | 941-879-6041
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Fax |
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Provider Business Mailing Address
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Address Line | 230 BURNEY RD
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City | OSPREY
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State | FL
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Zip | 34229-9444
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Country | US
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Telephone | 941-879-6041
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Fax |
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Authorized Official
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Title or Position | OWNER/ DIRECTOR
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Name | MISS KRISTINA LEI GRAHAM
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Credential | LMT
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Telephone | 941-879-6041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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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 | 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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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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