Provider Demographics
NPI:1669768792
Name:THERAPEUTIC MOBILE SPA
Entity type:Organization
Organization Name:THERAPEUTIC MOBILE SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALBITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-431-5764
Mailing Address - Street 1:1045 KANE CONCOURSE
Mailing Address - Street 2:SUITE #214
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2119
Mailing Address - Country:US
Mailing Address - Phone:305-431-5764
Mailing Address - Fax:305-485-5959
Practice Address - Street 1:1045 KANE CONCOURSE
Practice Address - Street 2:SUITE #214
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2119
Practice Address - Country:US
Practice Address - Phone:305-431-5764
Practice Address - Fax:305-485-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center