MEDICARE: TRANQUIL KNEADS, LLC

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

General Provider Information

NPI Number	:	1235641721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANQUIL KNEADS, LLC

Provider Business Mailing Address
First Line	:	5041 NE 15TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33334-5753
Country	:	US
Telephone Number	:	561-843-6489
Fax Number	:

Provider Business Practice Location Address
First Line	:	4861 N DIXIE HWY STE 204
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33334-3953
Country	:	US
Telephone Number	:	754-229-9235
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ MASSAGE THERAPIST
Name	:	MICHELLE M LINDENAU
Credential	:	LMT
Telephone Number	:	754-229-9235

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	11/17/2021

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