MEDICARE: TARRHEA'S TRANQUIL TOUCH,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	305R00000X	Preferred Provider Organization	MA43585	FL

General Provider Information

NPI Number	:	1427415504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARRHEA'S TRANQUIL TOUCH,LLC

Provider Business Mailing Address
First Line	:	3479 NW 23RD ST
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33311-2602
Country	:	US
Telephone Number	:	954-805-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3479 NW 23RD ST
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33311-2602
Country	:	US
Telephone Number	:	954-805-4800
Fax Number	:

Authorized Official
Title or Position	:	LICENSE MASSAGE THERAPIST
Name	:	MS. TARRHEA MONEE HOLLINGSWORTH
Credential	:	LMT
Telephone Number	:	954-805-4800

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	01/21/2016

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