=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497037345
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERMAL THERAPY MED SPA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2011
-----------------------------------------------------
Last Update Date | 09/16/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 GLEN IRIS DR NE #3425
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30308-2963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-819-0061
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 525 GLEN IRIS DR NE #1101
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30308-2963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-819-0061
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MR. DAVID LUDWIG FRITSCH
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 404-819-0061
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | MT006973
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------