Provider Demographics
NPI:1184165532
Name:LUXURY QUALITY TYME INC
Entity type:Organization
Organization Name:LUXURY QUALITY TYME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMT
Authorized Official - Prefix:
Authorized Official - First Name:LYNDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:II
Authorized Official - Credentials:LMT
Authorized Official - Phone:561-801-8002
Mailing Address - Street 1:717 45TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2929
Mailing Address - Country:US
Mailing Address - Phone:561-801-8002
Mailing Address - Fax:561-844-4166
Practice Address - Street 1:717 45TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2929
Practice Address - Country:US
Practice Address - Phone:561-801-8002
Practice Address - Fax:561-844-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-18
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA66976225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL623618300OtherLUXURY QUALITY TYME INC WORKER'S COMP NUMBER
FL13950338OtherLUXURY QUALITY TYME INC CAQH NUMBER
FLMA66976OtherLUXURY QUALITY TYME INC MASSAGE LICENSE NUMBER
FLMA66976OtherLUXURY QUALITY TYME INC MASSAGE LICENSE NUMBER