=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548692999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUL BEAUTIFUL DAY SPA & WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2013
-----------------------------------------------------
Last Update Date | 08/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7929 GRAND BLVD
-----------------------------------------------------
City | PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34668-6658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-845-7685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7929 GRAND BLVD
-----------------------------------------------------
City | PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34668-6658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-845-7685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MASSAGE THERAPIST
-----------------------------------------------------
Name | JENNIFER YVETTE SANCHEZ
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 727-845-7685
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | CH2814
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------