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Organization
SPA NORTHWEST LLC
Active
Organization
SPA NORTHWEST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MARIE SKINNER LMT (OWNER)
(941) 577-6560
Entity
Organization
Contact information
Practice address
5701 21ST AVE W, BRADENTON, FL 34209-5605
(941) 713-1637
Mailing address
5701 21ST AVE W, BRADENTON, FL 34209-5605
(941) 713-1637
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
09/15/2023
Last updated
09/15/2023
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