Provider Demographics
NPI:1659098465
Name:TRINITY THERAPEUTIC MASSAGE, LLC
Entity type:Organization
Organization Name:TRINITY THERAPEUTIC MASSAGE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-534-5019
Mailing Address - Street 1:4916 SHELL STREAM BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4439
Mailing Address - Country:US
Mailing Address - Phone:727-300-2668
Mailing Address - Fax:
Practice Address - Street 1:4916 SHELL STREAM BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4439
Practice Address - Country:US
Practice Address - Phone:727-300-2668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty