Provider Demographics
NPI:1508758277
Name:DRIFT AWAY THERAPEUTIC MASSAGE LLC
Entity type:Organization
Organization Name:DRIFT AWAY THERAPEUTIC MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT/HEALTH COACH
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERLINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ-WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-768-6178
Mailing Address - Street 1:200 W ORION DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-6626
Mailing Address - Country:US
Mailing Address - Phone:254-768-6178
Mailing Address - Fax:
Practice Address - Street 1:1010 W JASPER DR STE 6
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-1328
Practice Address - Country:US
Practice Address - Phone:254-768-6178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty