Provider Demographics
NPI:1942518279
Name:AFFORDABLE SPA
Entity Type:Organization
Organization Name:AFFORDABLE SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:ARTURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-625-2141
Mailing Address - Street 1:2062 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4285
Mailing Address - Country:US
Mailing Address - Phone:321-452-0111
Mailing Address - Fax:
Practice Address - Street 1:2062 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4285
Practice Address - Country:US
Practice Address - Phone:321-452-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM21446172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty