Provider Demographics
NPI:1790043073
Name:BROWN, TRINA TORSTRICK (LMT, CMT)
Entity Type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:TORSTRICK
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 S COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-7903
Mailing Address - Country:US
Mailing Address - Phone:812-569-1912
Mailing Address - Fax:
Practice Address - Street 1:2535 S COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-7903
Practice Address - Country:US
Practice Address - Phone:812-569-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT20901301225700000X
KYKY-0967225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist