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General NPI Number Information
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NPI Number | 1205510054
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Entity Type | Organization
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Legal Business Name | SAP AND SOUL DAY SPA LLC
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 920 PAVERSTONE DR STE B
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City | RALEIGH
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State | NC
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Zip | 27615-4723
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Country | US
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Telephone | 919-228-8501
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Fax |
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Provider Business Mailing Address
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Address Line | 5129 CHASTEAL TRL
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City | RALEIGH
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State | NC
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Zip | 27610-6421
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Country | US
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Telephone | 919-616-9252
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHNTAE LANA BAILEY
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Credential | MASSAGE THERAPIST
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Telephone | 910-859-0667
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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 |
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License Number State |
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