Provider Demographics
NPI:1023030970
Name:TRENTACOSTA, JAMES ANTHONY (LMT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANTHONY
Last Name:TRENTACOSTA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:MR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:TRENTACOSTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:96 DOLPHIN BLVD E
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1713
Mailing Address - Country:US
Mailing Address - Phone:904-285-5566
Mailing Address - Fax:904-543-1488
Practice Address - Street 1:96 DOLPHIN BLVD E
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1713
Practice Address - Country:US
Practice Address - Phone:904-285-5566
Practice Address - Fax:904-543-1488
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA13773225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC7842OtherBLUE CROSS PROVIDER
FLMA13773OtherLICENSE NUMBER