Provider Demographics
NPI:1740420348
Name:BALANCE DAY SPA
Entity Type:Organization
Organization Name:BALANCE DAY SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MASSAGE PRACTITONER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-427-3189
Mailing Address - Street 1:117 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-2564
Mailing Address - Country:US
Mailing Address - Phone:360-427-3189
Mailing Address - Fax:
Practice Address - Street 1:117 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2564
Practice Address - Country:US
Practice Address - Phone:360-427-3189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014205172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty