| Organization Name: | BARE A SPA STUDIO |
| NPI Number: | 1366826471 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LETICIA ROMAN (LMT) |
| Mailing Address: | 297 Nw 3rd St Prineville |
| State: | OR US |
| Postal Code: | 977541841 |
| Phone Number: | 5412796025 |
| Fax Number: | |
| NPI Enumeration Date: | 07/17/2015 |
| NPI Last Update Date: | 07/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | 17244 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |