=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477338929
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A TOUCH OF RELIEF, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2023
-----------------------------------------------------
Last Update Date | 08/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 983 ATLANTIC BLVD # 114
-----------------------------------------------------
City | ATLANTIC BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32233-3311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-383-5885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1339 VIOLET ST
-----------------------------------------------------
City | ATLANTIC BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32233-2635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-383-5885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LORI A SHERBAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-383-5885
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------