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General NPI Number Information
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NPI Number | 1083169825
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Entity Type | Organization
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Legal Business Name | MELTDOWN DAY SPA
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 105 11TH ST NE
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City | WATERTOWN
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State | SD
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Zip | 57201-2852
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Country | US
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Telephone | 605-520-9320
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Fax |
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Provider Business Mailing Address
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Address Line | 105 11TH ST NE
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City | WATERTOWN
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State | SD
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Zip | 57201-2852
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Country | US
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Telephone | 605-520-9320
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS TERESA JANE SHAPE
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Credential | LMT
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Telephone | 605-520-9320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT10532
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License Number State | SD
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