MEDICARE: THERASSAGE BODYWORKS 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1639967938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERASSAGE BODYWORKS LLC

Provider Business Mailing Address
First Line	:	1832 AFSHIN CT
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-6002
Country	:	US
Telephone Number	:	863-617-8682
Fax Number	:

Provider Business Practice Location Address
First Line	:	1832 AFSHIN CT
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-6002
Country	:	US
Telephone Number	:	863-617-8682
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AUSTIN BAKER
Credential	:	D.C.
Telephone Number	:	863-617-8682

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	04/28/2025

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Directions to “THERASSAGE BODYWORKS LLC ” Practice Location

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