Provider Demographics
NPI:1104044866
Name:WELLINGTON'S PREMIER DAY SPA
Entity Type:Organization
Organization Name:WELLINGTON'S PREMIER DAY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BAILEY
Authorized Official - Middle Name:KRISTEN
Authorized Official - Last Name:HASTINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-804-1111
Mailing Address - Street 1:9116 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6564
Mailing Address - Country:US
Mailing Address - Phone:561-804-1111
Mailing Address - Fax:561-804-1112
Practice Address - Street 1:9116 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33411-6564
Practice Address - Country:US
Practice Address - Phone:561-804-1111
Practice Address - Fax:561-804-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty