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General NPI Number Information
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NPI Number | 1619756921
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Entity Type | Organization
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Legal Business Name | OPULENT BODY WELLNESS AND DAY SPA
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 325 N FAIRVIEW RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27801-6065
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Country | US
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Telephone | 252-366-7001
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 HAZELNUT DR
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City | RALEIGH
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State | NC
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Zip | 27610-4933
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Country | US
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Telephone | 919-532-9837
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | FELISE MONOCELL KNIGHT
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Credential | MSED
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Telephone | 919-532-9837
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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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