MEDICARE: MASSAGE TRINITY GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QP2000X	Physical Therapy Clinic/Center
3	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1013755719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASSAGE TRINITY GROUP

Provider Business Mailing Address
First Line	:	6015 CHESTER CIR STE 206
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2273
Country	:	US
Telephone Number	:	904-412-6415
Fax Number	:

Provider Business Practice Location Address
First Line	:	6015 CHESTER CIR STE 206
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2273
Country	:	US
Telephone Number	:	904-365-8305
Fax Number	:	904-365-8198

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. NICOLE SMITH
Credential	:
Telephone Number	:	904-365-8305

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	07/17/2024

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