Healthcare Provider Details

I. General information

NPI: 1922330695
Provider Name (Legal Business Name): ESCAPE DAY SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 BROADWAY ST SUITE C
ROCK SPRINGS WY
82901-6381
US

IV. Provider business mailing address

617 BROADWAY SUITE C
ROCK SPRINGS WY
82901
US

V. Phone/Fax

Practice location:
  • Phone: 307-362-5005
  • Fax: 307-362-5202
Mailing address:
  • Phone: 307-362-5005
  • Fax: 307-362-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MISTY HAY
Title or Position: OWNER, MASSAGE THERAPIST
Credential: CMT, EMT-B
Phone: 307-362-5005