MEDICARE: TRINITY THERAPEUTIC MASSAGE, 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	:	1659098465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRINITY THERAPEUTIC MASSAGE, LLC

Provider Business Mailing Address
First Line	:	4916 SHELL STREAM BLVD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4439
Country	:	US
Telephone Number	:	727-300-2668
Fax Number	:

Provider Business Practice Location Address
First Line	:	4916 SHELL STREAM BLVD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4439
Country	:	US
Telephone Number	:	727-300-2668
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JERRICA GLAESER
Credential	:
Telephone Number	:	727-534-5019

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	07/26/2023

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