Organization Name: | SPA BLU |
NPI Number: | 1063656791 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KRISTA DUMBLETON (OWNER/LMT) |
Mailing Address: | 57 Uptown Grayton Cir Ste A Santa Rosa Beach |
State: | FL US |
Postal Code: | 324598814 |
Phone Number: | 8502315784 |
Fax Number: | 8502314718 |
NPI Enumeration Date: | 04/24/2009 |
NPI Last Update Date: | 04/24/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MM16325 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |