Provider Demographics
NPI:1003435223
Name:REISCH GROUP LLC ( DBA SPA WELLNESS SERVICES)
Entity type:Organization
Organization Name:REISCH GROUP LLC ( DBA SPA WELLNESS SERVICES)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:305-498-5618
Mailing Address - Street 1:BOYNTON BEACH, FLORIDA
Mailing Address - Street 2:9066 PARAGON WAY
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472
Mailing Address - Country:US
Mailing Address - Phone:305-498-5618
Mailing Address - Fax:
Practice Address - Street 1:9066 PARAGON WAY
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-3347
Practice Address - Country:US
Practice Address - Phone:561-697-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA45837OtherMASSAGE THERAPY