=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760356992
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPAGNOLI MASSAGE THERAPY & WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2025
-----------------------------------------------------
Last Update Date | 10/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 141 MARK TREE RD
-----------------------------------------------------
City | CENTEREACH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11720-2221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-251-7577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 BIRCH HOLLOW CT
-----------------------------------------------------
City | STONY BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11790-1847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | HEATHER SPAGNOLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 631-251-7577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------