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General NPI Number Information
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NPI Number | 1104354133
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Entity Type | Organization
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Legal Business Name | SPA REMEDEASE, LLC
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Dates
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Enumeration Date | 06/03/2017
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Last Update Date | 06/03/2017
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Provider Practice Location Address
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Address Line | 4000 WESTCLIFF DR
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City | HOOD RIVER
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State | OR
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Zip | 97031-8711
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Country | US
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Telephone | 541-387-8451
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Fax |
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Provider Business Mailing Address
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Address Line | 1058 HIGH PRAIRIE RD
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City | LYLE
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State | WA
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Zip | 98635-9449
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Country | US
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Telephone | 16039913195
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARTINA RIZZO
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Credential | LMT
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Telephone | 603-991-3195
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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 | 20521
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License Number State | OR
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