Healthcare Provider Details

I. General information

NPI: 1104044866
Provider Name (Legal Business Name): WELLINGTON'S PREMIER DAY SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9116 FOREST HILL BLVD
WELLINGTON FL
33411-6564
US

IV. Provider business mailing address

9116 FOREST HILL BLVD
WELLINGTON FL
33411-6564
US

V. Phone/Fax

Practice location:
  • Phone: 561-804-1111
  • Fax: 561-804-1112
Mailing address:
  • Phone: 561-804-1111
  • Fax: 561-804-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. BAILEY KRISTEN HASTINGS
Title or Position: OWNER
Credential:
Phone: 561-804-1111