=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376712877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RELAXATIONS HEALTH & WELLNESS SPA, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2008
-----------------------------------------------------
Last Update Date | 02/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2790 W TENNESSEE ST SUITE 2
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32304-2840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-222-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2790 W TENNESSEE ST SUITE 2
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32304-2840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-222-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. STEPHANI DAWN LIPFORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-222-9355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MM20647
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------