Provider Demographics
NPI:1275770026
Name:REMEMBER SPA & WELLNESS CENTER
Entity Type:Organization
Organization Name:REMEMBER SPA & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSITSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:AVDZHIEVA
Authorized Official - Suffix:
Authorized Official - Credentials:BS IN PSYCHOLOGY
Authorized Official - Phone:386-677-1444
Mailing Address - Street 1:2627 N ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-3205
Mailing Address - Country:US
Mailing Address - Phone:386-677-1444
Mailing Address - Fax:
Practice Address - Street 1:2627 N ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-3205
Practice Address - Country:US
Practice Address - Phone:386-677-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45229225700000X
FLMA 44890225700000X
FLMM 21927225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty