Provider Demographics
NPI:1225752165
Name:RESTORATIVE THERAPY & WELLNESS SPA, INC.
Entity Type:Organization
Organization Name:RESTORATIVE THERAPY & WELLNESS SPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LATWANYA
Authorized Official - Middle Name:JANEA
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:214-384-6466
Mailing Address - Street 1:2100 N HWY 360 STE 2007B
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1045
Mailing Address - Country:US
Mailing Address - Phone:214-384-6466
Mailing Address - Fax:
Practice Address - Street 1:2100 N HWY 360 STE 2007B
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1045
Practice Address - Country:US
Practice Address - Phone:214-384-6466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty