Provider Demographics
NPI:1760617278
Name:TREE OF LIFE MASSAGE AND BODY WORKS, INC.
Entity Type:Organization
Organization Name:TREE OF LIFE MASSAGE AND BODY WORKS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANZALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-684-6424
Mailing Address - Street 1:4337 COMMERCIAL WAY PMB 111
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3319
Mailing Address - Country:US
Mailing Address - Phone:352-684-6424
Mailing Address - Fax:352-684-6423
Practice Address - Street 1:4212 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2325
Practice Address - Country:US
Practice Address - Phone:352-684-6424
Practice Address - Fax:352-684-6423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
FL194261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty