MEDICARE: TSL MASSAGE THERAPY PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist
2	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1194405100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TSL MASSAGE THERAPY PC

Provider Business Mailing Address
First Line	:	2 CLUB HOUSE LN
Second Line	:
City	:	MANORVILLE
State	:	NY
Zip	:	11949-2825
Country	:	US
Telephone Number	:	631-991-0052
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 MARINERS WAY
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777-1848
Country	:	US
Telephone Number	:	631-991-0052
Fax Number	:

Authorized Official
Title or Position	:	CEO & FOUNDER
Name	:	TARA LAWLESS
Credential	:
Telephone Number	:	631-991-0052

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	04/17/2025

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