Provider Demographics
NPI:1902626377
Name:KSPA MASSAGE & COMPANY, LLC.
Entity type:Organization
Organization Name:KSPA MASSAGE & COMPANY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KNITHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPIST
Authorized Official - Phone:254-498-9516
Mailing Address - Street 1:7524 BOSQUE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3772
Mailing Address - Country:US
Mailing Address - Phone:254-498-9516
Mailing Address - Fax:
Practice Address - Street 1:7524 BOSQUE BLVD STE D
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3772
Practice Address - Country:US
Practice Address - Phone:254-498-9516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty