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General NPI Number Information
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NPI Number | 1740735190
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Entity Type | Organization
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Legal Business Name | MASSAGE AND WELLNESS, LLC
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 118 W BAY DR SUITE 121
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City | LARGO
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State | FL
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Zip | 33770-3362
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Country | US
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Telephone | 727-459-2861
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Fax |
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Provider Business Mailing Address
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Address Line | 118 W BAY DR SUITE 121
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City | LARGO
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State | FL
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Zip | 33770-3362
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Country | US
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Telephone | 727-459-2861
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | MR. THOMAS A ROSSEWEY
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Credential | LMT,CCA,PTA
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Telephone | 727-459-2861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PTA23653
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License Number State | FL
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