Provider Demographics
NPI:1497287361
Name:HOLISTIC HEALTH & WELLNESS MEDICAL SPA
Entity Type:Organization
Organization Name:HOLISTIC HEALTH & WELLNESS MEDICAL SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:SHAWANDA
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:301-772-1500
Mailing Address - Street 1:1450 MERCANTILE LN
Mailing Address - Street 2:221
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5376
Mailing Address - Country:US
Mailing Address - Phone:301-772-1500
Mailing Address - Fax:
Practice Address - Street 1:1450 MERCANTILE LN
Practice Address - Street 2:221
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5376
Practice Address - Country:US
Practice Address - Phone:301-772-1500
Practice Address - Fax:301-773-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty