Healthcare Provider Details

I. General information

NPI: 1861916843
Provider Name (Legal Business Name): PERSONAL TOUCH MEDICAL SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/21/2022
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MERCANTILE LANE SUITE 221
LARGO MD
20774
US

IV. Provider business mailing address

1450 MERCANTILE LN STE 221
LARGO MD
20774-5376
US

V. Phone/Fax

Practice location:
  • Phone: 301-772-1500
  • Fax:
Mailing address:
  • Phone: 301-772-1500
  • Fax: 301-773-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOYCE S EDWARDS
Title or Position: OWNER
Credential:
Phone: 301-772-1500