Provider Demographics
NPI:1154755874
Name:EXHALE SPA THERAPY, LLC
Entity type:Organization
Organization Name:EXHALE SPA THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPA DIRECTOR, LMT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-232-3233
Mailing Address - Street 1:575 S WILLOW ST
Mailing Address - Street 2:F2
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-5713
Mailing Address - Country:US
Mailing Address - Phone:603-232-3233
Mailing Address - Fax:
Practice Address - Street 1:575 S WILLOW ST
Practice Address - Street 2:F2
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5713
Practice Address - Country:US
Practice Address - Phone:603-232-3233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3485M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty