MEDICARE: REISCH GROUP LLC ( DBA SPA WELLNESS SERVICES)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1003435223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REISCH GROUP LLC ( DBA SPA WELLNESS SERVICES)

Provider Business Mailing Address
First Line	:	BOYNTON BEACH, FLORIDA
Second Line	:	9066 PARAGON WAY
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472
Country	:	US
Telephone Number	:	305-498-5618
Fax Number	:

Provider Business Practice Location Address
First Line	:	9066 PARAGON WAY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-3347
Country	:	US
Telephone Number	:	561-697-8800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLETTE WHITE
Credential	:	LMT
Telephone Number	:	305-498-5618

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	04/17/2020

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