Provider Demographics
NPI:1083921613
Name:JD THERAPY CENTER AND SPA
Entity Type:Organization
Organization Name:JD THERAPY CENTER AND SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:YENNIFFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-597-3696
Mailing Address - Street 1:3900 NW 79TH AVE
Mailing Address - Street 2:SUITE 429
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 NW 79TH AVE
Practice Address - Street 2:SUITE 429
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6556
Practice Address - Country:US
Practice Address - Phone:305-597-3696
Practice Address - Fax:305-596-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty