Provider Demographics
NPI:1023604709
Name:INDIGO WELLNESS SPA, LLC
Entity type:Organization
Organization Name:INDIGO WELLNESS SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:276-692-7468
Mailing Address - Street 1:209 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3714
Mailing Address - Country:US
Mailing Address - Phone:276-634-0184
Mailing Address - Fax:
Practice Address - Street 1:209 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3714
Practice Address - Country:US
Practice Address - Phone:276-634-0184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty