Provider Demographics
NPI:1265599526
Name:ENIGMA SALON AND SPA INC
Entity type:Organization
Organization Name:ENIGMA SALON AND SPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND MASSAGE TERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:NOELLE
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-297-3723
Mailing Address - Street 1:2908 ROLLING BROAK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7469
Mailing Address - Country:US
Mailing Address - Phone:321-297-3723
Mailing Address - Fax:
Practice Address - Street 1:10335 ORANGEWOOD BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-8285
Practice Address - Country:US
Practice Address - Phone:321-297-3723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL42456225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty