Provider Demographics
NPI:1013797810
Name:REFLECTIONS MEDISPA, LLC
Entity type:Organization
Organization Name:REFLECTIONS MEDISPA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS-TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-299-4256
Mailing Address - Street 1:8129 HARMONY WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-1302
Mailing Address - Country:US
Mailing Address - Phone:812-590-3800
Mailing Address - Fax:812-203-5678
Practice Address - Street 1:7104 NOVAS LNDG
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1899
Practice Address - Country:US
Practice Address - Phone:502-299-4256
Practice Address - Fax:812-203-5678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INMT22408461OtherMASSAGE THERAPIST