Healthcare Provider Details

I. General information

NPI: 1750109716
Provider Name (Legal Business Name): KRM SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 NE 191ST ST APT 140
MIAMI FL
33179-4106
US

IV. Provider business mailing address

1540 NE 191ST ST APT 140
MIAMI FL
33179-4106
US

V. Phone/Fax

Practice location:
  • Phone: 786-200-4312
  • Fax:
Mailing address:
  • Phone: 786-200-4312
  • 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: KATHERINE R MANCILLA
Title or Position: MASSAGE THERAPIST
Credential: LMT
Phone: 786-200-4312