Provider Demographics
NPI:1114784162
Name:THE COTTAGE DAY SPA
Entity Type:Organization
Organization Name:THE COTTAGE DAY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARCELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMIAN NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:772-812-3263
Mailing Address - Street 1:100 S 2ND ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4306
Mailing Address - Country:US
Mailing Address - Phone:772-812-3263
Mailing Address - Fax:
Practice Address - Street 1:100 S 2ND ST UNIT 203
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4306
Practice Address - Country:US
Practice Address - Phone:772-812-3263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty