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General NPI Number Information
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NPI Number | 1295081719
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Entity Type | Organization
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Legal Business Name | SPA THERAPY WELLNESS CENTER
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 08/02/2012
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Provider Practice Location Address
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Address Line | 1528 PLUMAS CT SUITE#300
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City | YUBA CITY
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State | CA
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Zip | 95991-2972
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Country | US
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Telephone | 530-751-5166
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Fax | 530-751-1575
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Provider Business Mailing Address
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Address Line | 1528 PLUMAS CT SUITE#300
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City | YUBA CITY
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State | CA
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Zip | 95991-2972
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Country | US
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Telephone | 530-751-5166
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Fax | 530-751-1575
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Authorized Official
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Title or Position | OWNER, MEDICAL MASSAGE
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Name | MRS. JENNIFER LEE NAGY-CORDRAY
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Credential | CMT
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Telephone | 530-751-5166
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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 | 15101
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License Number State | CA
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