Provider Demographics
NPI:1013797810
Name:REFLECTIONS MEDISPA, LLC
Entity Type:Organization
Organization Name:REFLECTIONS MEDISPA, LLC
Other - Org Name:REFLECTIONS FOR VETERANS COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS-TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-299-4256
Mailing Address - Street 1:8129 HARMONY WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-1302
Mailing Address - Country:US
Mailing Address - Phone:812-590-3800
Mailing Address - Fax:812-203-5678
Practice Address - Street 1:941 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1615
Practice Address - Country:US
Practice Address - Phone:812-590-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty