Provider Demographics
NPI:1881990497
Name:REGATTA POINT THERAPY & WELLNESS
Entity type:Organization
Organization Name:REGATTA POINT THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERNOORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-586-0808
Mailing Address - Street 1:1065 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5008
Mailing Address - Country:US
Mailing Address - Phone:941-722-2777
Mailing Address - Fax:
Practice Address - Street 1:1065 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5008
Practice Address - Country:US
Practice Address - Phone:941-722-2777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSPARATIONS HAIR AND SPA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA4253225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty