Provider Demographics
NPI:1588088256
Name:TEMPLES HOLISTIC WELLNESS, LLC
Entity type:Organization
Organization Name:TEMPLES HOLISTIC WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIER
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:SPELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CEO
Authorized Official - Phone:321-987-2389
Mailing Address - Street 1:2263 W NEW HAVEN AVE # 221
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3805
Mailing Address - Country:US
Mailing Address - Phone:321-987-2389
Mailing Address - Fax:
Practice Address - Street 1:2263 W NEW HAVEN AVE # 221
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3805
Practice Address - Country:US
Practice Address - Phone:321-987-2389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA63118225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty