Provider Demographics
NPI:1013755719
Name:MASSAGE TRINITY GROUP
Entity type:Organization
Organization Name:MASSAGE TRINITY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-365-8305
Mailing Address - Street 1:6015 CHESTER CIR STE 206
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2273
Mailing Address - Country:US
Mailing Address - Phone:904-412-6415
Mailing Address - Fax:
Practice Address - Street 1:6015 CHESTER CIR STE 206
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2273
Practice Address - Country:US
Practice Address - Phone:904-365-8305
Practice Address - Fax:904-365-8198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251S00000XAgenciesCommunity/Behavioral Health
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy