Provider Demographics
NPI:1588236830
Name:UP NORTH WELLNESS AND MASSAGE LLC
Entity Type:Organization
Organization Name:UP NORTH WELLNESS AND MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MADELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:231-489-8008
Mailing Address - Street 1:2780 CHARLEVOIX RD STE 12
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8058
Mailing Address - Country:US
Mailing Address - Phone:231-489-8008
Mailing Address - Fax:
Practice Address - Street 1:2780 CHARLEVOIX RD STE 12
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8058
Practice Address - Country:US
Practice Address - Phone:231-489-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty