Provider Demographics
NPI:1497037345
Name:THERMAL THERAPY MED SPA
Entity Type:Organization
Organization Name:THERMAL THERAPY MED SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LUDWIG
Authorized Official - Last Name:FRITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:404-819-0061
Mailing Address - Street 1:525 GLEN IRIS DR NE
Mailing Address - Street 2:#1101
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2963
Mailing Address - Country:US
Mailing Address - Phone:404-819-0061
Mailing Address - Fax:
Practice Address - Street 1:525 GLEN IRIS DR NE
Practice Address - Street 2:#3425
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2963
Practice Address - Country:US
Practice Address - Phone:404-819-0061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT006973251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMT006973OtherMASSAGE, HEAT THERAPY