Provider Demographics
NPI:1740754969
Name:LEVISA MASSAGE SPA WELLNES LLC.
Entity Type:Organization
Organization Name:LEVISA MASSAGE SPA WELLNES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DELANO
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-977-4754
Mailing Address - Street 1:3104 W WATERS AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2876
Mailing Address - Country:US
Mailing Address - Phone:813-440-3281
Mailing Address - Fax:
Practice Address - Street 1:3104 W WATERS AVE STE 105
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2876
Practice Address - Country:US
Practice Address - Phone:813-440-3281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty