Provider Demographics
NPI:1053632232
Name:BAUGHMAN, TRICIA JO (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:JO
Last Name:BAUGHMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 NE 8TH AVE
Mailing Address - Street 2:#410
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3580
Mailing Address - Country:US
Mailing Address - Phone:954-240-9068
Mailing Address - Fax:954-474-6794
Practice Address - Street 1:450 COMMODORE DR APT 303
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325-2157
Practice Address - Country:US
Practice Address - Phone:954-240-9068
Practice Address - Fax:954-474-6794
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-0016761171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA-0016761OtherLICENSED MASSAGE THERAPIST