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General NPI Number Information
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NPI Number | 1659098465
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Entity Type | Organization
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Legal Business Name | TRINITY THERAPEUTIC MASSAGE, LLC
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 4916 SHELL STREAM BLVD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4439
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Country | US
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Telephone | 727-300-2668
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Fax |
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Provider Business Mailing Address
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Address Line | 4916 SHELL STREAM BLVD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4439
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Country | US
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Telephone | 727-300-2668
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JERRICA GLAESER
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Credential |
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Telephone | 727-534-5019
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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 |
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License Number State |
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