Provider Demographics
NPI:1982430708
Name:DRIFTWOOD YOGA, SPA & BOUTIQUE, INC.
Entity type:Organization
Organization Name:DRIFTWOOD YOGA, SPA & BOUTIQUE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REGALADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-476-2431
Mailing Address - Street 1:294 N NC 16 BUSINESS HWY STE B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8741
Mailing Address - Country:US
Mailing Address - Phone:813-476-2431
Mailing Address - Fax:
Practice Address - Street 1:294 N NC 16 BUSINESS HWY STE B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8741
Practice Address - Country:US
Practice Address - Phone:813-476-2431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty