Provider Demographics
NPI:1437679008
Name:SPRINGBROOK WELLNESS LLC
Entity Type:Organization
Organization Name:SPRINGBROOK WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NIEZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-412-5727
Mailing Address - Street 1:3715 80TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-4950
Mailing Address - Country:US
Mailing Address - Phone:262-358-1975
Mailing Address - Fax:
Practice Address - Street 1:3715 80TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-4950
Practice Address - Country:US
Practice Address - Phone:262-358-1975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty