Healthcare Provider Details

I. General information

NPI: 1093350886
Provider Name (Legal Business Name): CONTINENTAL SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W CONTINENTAL RD STE 130A
GREEN VALLEY AZ
85622-3546
US

IV. Provider business mailing address

210 W CONTINENTAL RD STE 130A
GREEN VALLEY AZ
85622-3546
US

V. Phone/Fax

Practice location:
  • Phone: 520-906-8358
  • Fax:
Mailing address:
  • Phone: 520-906-8358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: REBECCA R WILLER
Title or Position: OWNER
Credential:
Phone: 520-906-8358