Provider Demographics
NPI:1073397980
Name:BE PAMPERED FOOT SPA 1, LLC
Entity Type:Organization
Organization Name:BE PAMPERED FOOT SPA 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CERTIFIED PODALOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-768-0022
Mailing Address - Street 1:4130 SALISBURY RD STE 1020
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0948
Mailing Address - Country:US
Mailing Address - Phone:904-768-0022
Mailing Address - Fax:
Practice Address - Street 1:4130 SALISBURY RD STE 1020
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0948
Practice Address - Country:US
Practice Address - Phone:904-768-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center