Provider Demographics
NPI:1396916375
Name:AVALON MASSAGE AND DAY SPA LTD LIMITED
Entity type:Organization
Organization Name:AVALON MASSAGE AND DAY SPA LTD LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-582-9977
Mailing Address - Street 1:660 W EVERGREEN FARM WAY
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-5097
Mailing Address - Country:US
Mailing Address - Phone:360-582-9977
Mailing Address - Fax:360-582-9972
Practice Address - Street 1:660 W EVERGREEN FARM WAY
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-5097
Practice Address - Country:US
Practice Address - Phone:360-582-9977
Practice Address - Fax:360-582-9972
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVALON MASSAGE AND DAY SPA LTD LIMITED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017716172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty