Provider Demographics
NPI:1699515130
Name:BLUE DOOR SPA AND SALON INC
Entity type:Organization
Organization Name:BLUE DOOR SPA AND SALON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:NAGY
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:941-720-4402
Mailing Address - Street 1:5234 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5524
Mailing Address - Country:US
Mailing Address - Phone:941-747-0111
Mailing Address - Fax:
Practice Address - Street 1:5234 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5524
Practice Address - Country:US
Practice Address - Phone:941-747-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty