1023030970 NPI number — MR. JAMES ANTHONY TRENTACOSTA L.M.T.

Table of content: MR. JAMES ANTHONY TRENTACOSTA L.M.T. (NPI 1023030970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023030970 NPI number — MR. JAMES ANTHONY TRENTACOSTA L.M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRENTACOSTA
Provider First Name:
JAMES
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.M.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRENTACOSTA
Provider Other First Name:
TONY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.T.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023030970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96 DOLPHIN BLVD E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONTE VEDRA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32082-1713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-285-5566
Provider Business Mailing Address Fax Number:
904-543-1488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
96 DOLPHIN BLVD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONTE VEDRA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32082-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-285-5566
Provider Business Practice Location Address Fax Number:
904-543-1488
Provider Enumeration Date:
07/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA13773 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C7842 . This is a "BLUE CROSS PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: MA13773 . This is a "LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".