Provider Demographics
NPI:1295081719
Name:SPA THERAPY WELLNESS CENTER
Entity type:Organization
Organization Name:SPA THERAPY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEDICAL MASSAGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NAGY-CORDRAY
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:530-751-5166
Mailing Address - Street 1:1528 PLUMAS CT
Mailing Address - Street 2:SUITE#300
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-2972
Mailing Address - Country:US
Mailing Address - Phone:530-751-5166
Mailing Address - Fax:530-751-1575
Practice Address - Street 1:1528 PLUMAS CT
Practice Address - Street 2:SUITE#300
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-2972
Practice Address - Country:US
Practice Address - Phone:530-751-5166
Practice Address - Fax:530-751-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15101225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty