Provider Demographics
NPI:1982399564
Name:THE MAGNOLIA DAY SPA LLC
Entity Type:Organization
Organization Name:THE MAGNOLIA DAY SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:MIYORI
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMT # 2004
Authorized Official - Phone:662-390-4920
Mailing Address - Street 1:4280 HARLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-6604
Mailing Address - Country:US
Mailing Address - Phone:662-390-4920
Mailing Address - Fax:
Practice Address - Street 1:4280 HARLOW BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-6604
Practice Address - Country:US
Practice Address - Phone:662-390-4920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty