Provider Demographics
NPI:1801581012
Name:HARBOR WELLNESS SPA & BODYWORKS ,LTD.
Entity type:Organization
Organization Name:HARBOR WELLNESS SPA & BODYWORKS ,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARGUILO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:631-568-8335
Mailing Address - Street 1:57 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-4924
Mailing Address - Country:US
Mailing Address - Phone:631-575-7905
Mailing Address - Fax:
Practice Address - Street 1:57 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-4924
Practice Address - Country:US
Practice Address - Phone:631-575-7905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty