Provider Demographics
NPI:1538293840
Name:MILLENNIUM SALON AND SPA, INC.
Entity Type:Organization
Organization Name:MILLENNIUM SALON AND SPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PREAT
Authorized Official - Suffix:
Authorized Official - Credentials:NCMMT
Authorized Official - Phone:570-823-0654
Mailing Address - Street 1:299 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-2201
Mailing Address - Country:US
Mailing Address - Phone:570-823-0654
Mailing Address - Fax:570-270-0449
Practice Address - Street 1:299 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-2201
Practice Address - Country:US
Practice Address - Phone:570-823-0654
Practice Address - Fax:570-270-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1186225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty