Provider Demographics
NPI:1801450044
Name:406 MASSAGE AND SPA, LLC
Entity type:Organization
Organization Name:406 MASSAGE AND SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEMLICKA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:406-853-2579
Mailing Address - Street 1:15 MACEE LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7479
Mailing Address - Country:US
Mailing Address - Phone:406-853-2579
Mailing Address - Fax:
Practice Address - Street 1:15 MACEE LN
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7479
Practice Address - Country:US
Practice Address - Phone:406-853-2579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty