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General NPI Number Information
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NPI Number | 1295980167
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Entity Type | Organization
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Legal Business Name | MERIDIANS SPA LLC
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 181 LAHAINALUNA RD STE D
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City | LAHAINA
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State | HI
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Zip | 96761-1585
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Country | US
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Telephone | 808-661-7200
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Fax | 808-443-0494
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Provider Business Mailing Address
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Address Line | 181 LAHAINALUNA RD STE D
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City | LAHAINA
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State | HI
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Zip | 96761-1585
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Country | US
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Telephone | 808-661-7200
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Fax | 808-443-0494
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Authorized Official
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Title or Position | OWNER
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Name | VIRGINIA LACKER
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Credential |
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Telephone | 808-661-7200
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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 | 2396
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License Number State | HI
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