Provider Demographics
NPI:1528380938
Name:WELLNESS MASSAGE STUDIOS-UNIVERSITY SHOPPES, INC
Entity Type:Organization
Organization Name:WELLNESS MASSAGE STUDIOS-UNIVERSITY SHOPPES, INC
Other - Org Name:ELEMENTS THERAPEUTIC MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BADIALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-468-9824
Mailing Address - Street 1:8109 COOPER CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34201-2004
Mailing Address - Country:US
Mailing Address - Phone:941-366-1168
Mailing Address - Fax:941-360-1125
Practice Address - Street 1:8109 COOPER CREEK BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-2004
Practice Address - Country:US
Practice Address - Phone:941-366-1168
Practice Address - Fax:941-360-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM22003225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty