Organization
THE WELLNESS SPA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LACEY GREEN LMT 1384 (OWNER/LICENSED MASSAGE THERAPIST)
(601) 479-5392
Entity
Organization
Contact information
Practice address
5419 HIGHWAY 25 STE R, FLOWOOD, MS 39232-6343
(601) 479-5392
Mailing address
5419 HIGHWAY 25 STE R, FLOWOOD, MS 39232-6343
(601) 479-5392
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
1384
MS
Other
Enumeration date
09/08/2016
Last updated
09/08/2016
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