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General NPI Number Information
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NPI Number | 1437340585
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Entity Type | Organization
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Legal Business Name | SANTA ROSA WELLNESS SPA, P.A.
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 12671 US HIGHWAY 98 W SUITE 211
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-8300
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Country | US
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Telephone | 850-654-6505
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Fax | 850-654-6505
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Provider Business Mailing Address
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Address Line | 12671 US HIGHWAY 98 W SUITE 211
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City | MIRAMAR BEACH
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State | FL
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Zip | 32550-8300
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Country | US
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Telephone | 850-654-6505
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Fax | 850-654-6505
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Authorized Official
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Title or Position | REGIONAL DIRECTOR
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Name | DANA A BERTHIAUME
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Credential | D.C.
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Telephone | 850-654-6505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH 8469
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License Number State | FL
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