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General NPI Number Information
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NPI Number | 1154755874
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Entity Type | Organization
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Legal Business Name | EXHALE SPA THERAPY, LLC
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 575 S WILLOW ST F2
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City | MANCHESTER
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State | NH
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Zip | 03103-5713
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Country | US
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Telephone | 603-232-3233
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Fax |
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Provider Business Mailing Address
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Address Line | 575 S WILLOW ST F2
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City | MANCHESTER
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State | NH
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Zip | 03103-5713
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Country | US
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Telephone | 603-232-3233
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Fax |
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Authorized Official
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Title or Position | SPA DIRECTOR, LMT
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Name | KIMBERLY GAGNON
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Credential |
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Telephone | 603-232-3233
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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 | 3485M
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License Number State | NH
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