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General NPI Number Information
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NPI Number | 1538293840
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Entity Type | Organization
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Legal Business Name | MILLENNIUM SALON AND SPA, INC.
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 299 S MAIN ST
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City | WILKES BARRE
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State | PA
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Zip | 18701-2201
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Country | US
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Telephone | 570-823-0654
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Fax | 570-270-0449
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Provider Business Mailing Address
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Address Line | 299 S MAIN ST
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City | WILKES BARRE
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State | PA
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Zip | 18701-2201
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Country | US
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Telephone | 570-823-0654
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Fax | 570-270-0449
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Authorized Official
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Title or Position | VICE PRESIDENT MASSAGE THERAPIST
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Name | MRS. GLORIA M PREAT
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Credential | NCMMT
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Telephone | 570-823-0654
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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 | 1186
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License Number State | PA
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