Provider Demographics
NPI:1407109663
Name:SELAH MEDI SPA AND REJUVINATION CENTER
Entity Type:Organization
Organization Name:SELAH MEDI SPA AND REJUVINATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-492-6334
Mailing Address - Street 1:21715 KINGSLAND BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2543
Mailing Address - Country:US
Mailing Address - Phone:281-492-6334
Mailing Address - Fax:281-492-6343
Practice Address - Street 1:21715 KINGSLAND BLVD
Practice Address - Street 2:STE 100
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2543
Practice Address - Country:US
Practice Address - Phone:281-492-6334
Practice Address - Fax:281-492-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193200000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty