Provider Demographics
NPI:1578907663
Name:SILVER DOOR SPA INC
Entity Type:Organization
Organization Name:SILVER DOOR SPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REISELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-571-2901
Mailing Address - Street 1:762 S RANGELINE RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3035
Mailing Address - Country:US
Mailing Address - Phone:317-816-7587
Mailing Address - Fax:
Practice Address - Street 1:762 S RANGELINE RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3035
Practice Address - Country:US
Practice Address - Phone:317-816-7587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SILVER DOOR SPA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-19
Last Update Date:2013-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty