Provider Demographics
NPI:1336360627
Name:BAGLIEN, TINA MARIE (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:BAGLIEN
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
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Mailing Address - Street 1:3745 NE 171ST STREET
Mailing Address - Street 2:#42
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:305-433-3613
Practice Address - Street 1:570 OCEAN DR
Practice Address - Street 2:#501 HOLISTIC MASSAGE CLINIC
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408
Practice Address - Country:US
Practice Address - Phone:954-491-2225
Practice Address - Fax:954-491-6862
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA27763OtherLICENSE NUMBER