MEDICARE: ANASTASIYA TRETYAKOVA

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	MA103993	FL

General Provider Information

NPI Number	:	1437080181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANASTASIYA TRETYAKOVA

Provider Business Mailing Address
First Line	:	2552 PLUNKETT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5844
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2552 PLUNKETT ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-5844
Country	:	US
Telephone Number	:	954-669-4686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ ANASTASIYA TRETYAKOVA ” Practice Location

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