Provider Demographics
NPI:1023999828
Name:THAI SPA PAVILION 3 LLC
Entity type:Organization
Organization Name:THAI SPA PAVILION 3 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-797-4535
Mailing Address - Street 1:39966 PREMIER DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-5760
Mailing Address - Country:US
Mailing Address - Phone:248-797-4535
Mailing Address - Fax:
Practice Address - Street 1:41875 W 11 MILE RD STE 201
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1877
Practice Address - Country:US
Practice Address - Phone:734-608-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty