Provider Demographics
NPI:1548582497
Name:LIFETHYME CAFE & WELLNESS
Entity Type:Organization
Organization Name:LIFETHYME CAFE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-597-2838
Mailing Address - Street 1:160 CYPRESS POINT PKWY
Mailing Address - Street 2:UNIT A105
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-8433
Mailing Address - Country:US
Mailing Address - Phone:386-597-2838
Mailing Address - Fax:
Practice Address - Street 1:160 CYPRESS POINT PKWY
Practice Address - Street 2:UNIT A105
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8433
Practice Address - Country:US
Practice Address - Phone:386-597-2838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM24216225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty