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General NPI Number Information
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NPI Number | 1306268420
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Entity Type | Organization
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Legal Business Name | TERRA ACQUA DAY SPA INC
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Dates
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Enumeration Date | 01/08/2014
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Last Update Date | 01/08/2014
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Provider Practice Location Address
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Address Line | 2700 N ATLANTIC AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-3005
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Country | US
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Telephone | 386-671-7661
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 N ATLANTIC AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32118-3005
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Country | US
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Telephone | 386-671-7661
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Fax |
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Authorized Official
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Title or Position | MANAGEMENT
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Name | MRS. STEPHANIE WILLIAMS
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Credential | HEALTHCARE
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Telephone | 386-671-1661
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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 | MM28224
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License Number State | FL
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