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General NPI Number Information
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NPI Number | 1265599526
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Entity Type | Organization
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Legal Business Name | ENIGMA SALON AND SPA INC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10335 ORANGEWOOD BLVD SUITE J
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City | ORLANDO
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State | FL
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Zip | 32821-8285
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Country | US
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Telephone | 321-297-3723
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Fax |
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Provider Business Mailing Address
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Address Line | 2908 ROLLING BROAK DR
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City | ORLANDO
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State | FL
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Zip | 32837-7469
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Country | US
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Telephone | 321-297-3723
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND MASSAGE TERAPIST
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Name | MICHELLE NOELLE BRADFORD
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Credential |
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Telephone | 321-297-3723
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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 | 42456
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License Number State | FL
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