Provider Demographics
NPI:1568220572
Name:SOAK SPA SHOP, LLC
Entity Type:Organization
Organization Name:SOAK SPA SHOP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-590-8869
Mailing Address - Street 1:2601 S LEMAY AVE UNIT 39
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2297
Mailing Address - Country:US
Mailing Address - Phone:970-377-9868
Mailing Address - Fax:
Practice Address - Street 1:2601 S LEMAY AVE UNIT 39
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2297
Practice Address - Country:US
Practice Address - Phone:970-377-9868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty