Provider Demographics
NPI:1558684548
Name:JA SPA, LLC
Entity Type:Organization
Organization Name:JA SPA, LLC
Other - Org Name:JA SPA & FITNESS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-673-3838
Mailing Address - Street 1:16 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-1118
Mailing Address - Country:US
Mailing Address - Phone:315-673-3838
Mailing Address - Fax:315-673-3866
Practice Address - Street 1:16 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:NY
Practice Address - Zip Code:13108-1118
Practice Address - Country:US
Practice Address - Phone:315-673-3838
Practice Address - Fax:315-673-3866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty