Provider Demographics
NPI:1962835843
Name:AXIOS HEALTH SPA, LLC
Entity Type:Organization
Organization Name:AXIOS HEALTH SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANTELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:YANDOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-285-3354
Mailing Address - Street 1:1424 TERRACE HOLLOW CT UNIT 1
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1122 THOMASVILLE RD STE 3
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-8702
Practice Address - Country:US
Practice Address - Phone:407-285-3354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL52193225700000X
FL33054225700000X
FL41296225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty