Provider Demographics
NPI:1972292233
Name:WATER STREET MASSAGE SPA LLC
Entity Type:Organization
Organization Name:WATER STREET MASSAGE SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASHONTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRENCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERPIST
Authorized Official - Phone:414-578-7447
Mailing Address - Street 1:823 N 2ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-1819
Mailing Address - Country:US
Mailing Address - Phone:414-273-9799
Mailing Address - Fax:
Practice Address - Street 1:823 N 2ND ST STE 102
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1819
Practice Address - Country:US
Practice Address - Phone:414-273-9799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty