Spa Blu

Primary specialty

SpecialistTaxonomy code 174400000X

License

MM16325 Issued in FL

Legal business name

SPA BLU

Practice address

57 Uptown Grayton Cir Ste a
Santa Rosa Beach, FL 32459-8814

Phone

(850) 231-5784

Fax

(850) 231-4718

NPI assigned

Apr 24, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Krista Dumbleton, LMT

Title

Owner/LMT

Phone

(850) 231-5784

Specialties & licenses 1

Addresses

Other names 1

• Spa Blu, Inc. Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240531200000",
    "number": "1063656791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 A UPTOWN GRAYTON CIRCLE",
            "city": "GRAYTON BEACH",
            "state": "FL",
            "postal_code": "32459",
            "telephone_number": "850-231-5784",
            "fax_number": "850-231-4718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 UPTOWN GRAYTON CIR STE A",
            "city": "SANTA ROSA BEACH",
            "state": "FL",
            "postal_code": "324598814",
            "telephone_number": "850-231-5784",
            "fax_number": "850-231-4718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPA BLU",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-24",
        "last_updated": "2009-04-24",
        "status": "A",
        "authorized_official_last_name": "DUMBLETON",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_title_or_position": "OWNER/LMT",
        "authorized_official_telephone_number": "850-231-5784",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "MM16325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spa Blu, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• South Walton Physical Therapy and Rehabilitation, Inc
• South Walton Therapy Contracting LLC (South Walton Physical Therapy & Wellness)
• Southern Meridian Inc (Santa Rosa Pharmacy)
• Southern Radiology Specialists of Destin PLLC (Dolphin Diagnostic Imaging)
• Southern Wellness, LLC
• Anna Carolina Spilere Furlan, MD
• Mark Springer, DC
• Cheryl Lynn Stacy, LCSW. MSW, MPH
• Benjamin Louie Stalnaker Jr., M.D.
• Stephen Mosley PA-C LLC

• Specialist in Santa Rosa Beach, FL
• Providers in Santa Rosa Beach, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.