=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790043073
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRINA TORSTRICK BROWN LMT, CMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2012
-----------------------------------------------------
Last Update Date | 03/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2535 S COUNTY FARM RD
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47167-7903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-569-1912
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2535 S COUNTY FARM RD
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47167-7903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-569-1912
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT20901301
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | KY-0967
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------