Provider Demographics
NPI:1902294531
Name:SEA GRASS THERAPIES MEDICAL SPA
Entity Type:Organization
Organization Name:SEA GRASS THERAPIES MEDICAL SPA
Other - Org Name:SEA GRASS THERAPIES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:AMMP
Authorized Official - Phone:978-973-0643
Mailing Address - Street 1:1 BRANCH ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1923
Mailing Address - Country:US
Mailing Address - Phone:978-973-0643
Mailing Address - Fax:978-984-5943
Practice Address - Street 1:1 BRANCH ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1923
Practice Address - Country:US
Practice Address - Phone:978-973-0643
Practice Address - Fax:978-984-5943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9326225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty