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General NPI Number Information
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NPI Number | 1457114654
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Entity Type | Organization
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Legal Business Name | LAKE ANNA SPA LLC
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 9942 KENTUCKY SPRINGS RD STE 10
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City | MINERAL
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State | VA
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Zip | 23117-4777
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Country | US
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Telephone | 540-642-6505
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Fax |
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Provider Business Mailing Address
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Address Line | 10706 HEATHERWOOD DR
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City | SPOTSYLVANIA
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State | VA
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Zip | 22553-1664
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Country | US
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Telephone | 540-642-6505
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/ MANAGER
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Name | KATHLEEN DEANGELO
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Credential |
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Telephone | 540-642-6505
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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 |
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License Number State |
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