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General NPI Number Information
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NPI Number | 1316269962
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Entity Type | Organization
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Legal Business Name | TRIUMPH SPORTS AND WELLNESS INC
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 137 SALEM CT
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City | TALLAHASSEE
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State | FL
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Zip | 32301-2809
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Country | US
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Telephone | 850-878-2363
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Fax | 850-878-2281
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Provider Business Mailing Address
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Address Line | 137 SALEM CT
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City | TALLAHASSEE
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State | FL
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Zip | 32301-2809
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Country | US
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Telephone | 850-878-2363
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Fax | 850-878-2281
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. CALLIE GRIFFIN
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Credential |
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Telephone | 850-878-2363
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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 | MM24406
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH8122
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License Number State | FL
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