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General NPI Number Information
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NPI Number | 1255835211
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Entity Type | Organization
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Legal Business Name | THE REFINERY MEDSPA AND WELLNES, LLC
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 03/22/2018
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Provider Practice Location Address
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Address Line | 4311 NORFOLK PKWY STE 114
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-8617
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Country | US
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Telephone | 321-722-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 E RIVER OAKS DR
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City | INDIALANTIC
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State | FL
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Zip | 32903-4630
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Country | US
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Telephone | 321-917-2217
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JARROD JAMES STOLDT
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Credential |
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Telephone | 321-917-2217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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