Provider Demographics
NPI:1194376939
Name:DOR LIFE SPA HEALING HANDS AND WELLNESS LLC
Entity Type:Organization
Organization Name:DOR LIFE SPA HEALING HANDS AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRENETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOR
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:561-557-4177
Mailing Address - Street 1:12794 FOREST HILL BLVD STE 18A
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4717
Mailing Address - Country:US
Mailing Address - Phone:561-557-4177
Mailing Address - Fax:
Practice Address - Street 1:12794 FOREST HILL BLVD STE 18A
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4717
Practice Address - Country:US
Practice Address - Phone:561-557-4177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty