Healthcare Provider Details

I. General information

NPI: 1992143853
Provider Name (Legal Business Name): LORDIS LOFT SALON & DAY SPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 KING ST
CHARLESTON SC
29401-1441
US

IV. Provider business mailing address

310 KING ST
CHARLESTON SC
29401-1441
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-3581
  • Fax:
Mailing address:
  • Phone: 843-789-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number89960
License Number StateSC

VIII. Authorized Official

Name: LINZIE ANN DAVIS-PADDOCK
Title or Position: PRESIDENT
Credential:
Phone: 843-789-3581