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General NPI Number Information
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NPI Number | 1013187574
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Entity Type | Organization
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Legal Business Name | DEBBIE'S DAY SPA & SALON
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 403 ANASTASIA BLVD
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-4508
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Country | US
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Telephone | 904-825-0569
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Fax |
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Provider Business Mailing Address
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Address Line | 403 ANASTASIA BLVD
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-4508
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Country | US
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Telephone | 904-825-0569
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONAL OFFICER
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Name | MR. SHANNON THEED
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Credential |
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Telephone | 904-825-0569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MM9360
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License Number State | FL
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