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General NPI Number Information
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NPI Number | 1508758277
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Entity Type | Organization
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Legal Business Name | DRIFT AWAY THERAPEUTIC MASSAGE LLC
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 1010 W JASPER DR STE 6
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City | KILLEEN
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State | TX
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Zip | 76542-1328
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Country | US
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Telephone | 254-768-6178
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Fax |
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Provider Business Mailing Address
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Address Line | 200 W ORION DR
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City | KILLEEN
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State | TX
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Zip | 76542-6626
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Country | US
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Telephone | 254-768-6178
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Fax |
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Authorized Official
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Title or Position | OWNER/LMT/HEALTH COACH
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Name | MRS. SHERLINDA MARQUEZ-WHITFIELD
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Credential |
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Telephone | 254-768-6178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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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 | 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 | 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 #5
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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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