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General NPI Number Information
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NPI Number | 1326390014
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Entity Type | Organization
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Legal Business Name | BELLA SPA
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 5121 OOLTEWAH RINGGOLD RD STE B2
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City | OOLTEWAH
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State | TN
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Zip | 37363-7287
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Country | US
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Telephone | 423-314-3005
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 96
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City | OOLTEWAH
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State | TN
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Zip | 37363-0096
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Country | US
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Telephone | 423-314-3005
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MS. KATE N. ALLEN
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Credential | LMT
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Telephone | 423-314-3005
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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 | 7191
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License Number State | TN
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