Organization
SPA BOUTIQUE 2GO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY GARNER LMT (OWNER)
(646) 626-0981
Entity
Organization
Contact information
Practice address
115 W 128TH ST, NEW YORK, NY 10027-3012
(646) 626-0981
Mailing address
16832 127TH AVE, 12D, JAMAICA, NY 11434-3156
(646) 626-0981
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
023837
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1149130
AMERICAN SPECIALTY HEALTH
NY
Enumeration date
10/17/2013
Last updated
10/17/2013
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