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General NPI Number Information
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NPI Number | 1891600797
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Entity Type | Organization
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Legal Business Name | DIVINE SPA LLC
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Dates
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Enumeration Date | 08/17/2026
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | 12280 BROADWAY ST STE 4120
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City | PEARLAND
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State | TX
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Zip | 77584-7868
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Country | US
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Telephone | 281-639-6665
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Fax |
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Provider Business Mailing Address
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Address Line | 4607 CROKER RIDGE RD
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City | HOUSTON
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State | TX
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Zip | 77053-3348
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Country | US
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Telephone | 281-639-6665
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIANNA STEPHANIE MONTIEL
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Credential |
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Telephone | 281-639-6665
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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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