The Spa 1 LLC

Primary specialty

NaturopathTaxonomy code 175F00000X

License

KY0196 Issued in KY

Legal business name

THE SPA 1 LLC

Practice address

929 Skyline Dr
Hopkinsville, KY 42240-5098

Phone

(270) 886-7721

NPI assigned

Feb 22, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Dale Grise, LMT, LE

Title

MGR

Phone

(270) 886-7721

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235264383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 SKYLINE DR",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422405098",
            "telephone_number": "270-886-7721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 SKYLINE DR",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422405098",
            "telephone_number": "270-886-7721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SPA 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRISE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "270-886-7721",
        "authorized_official_credential": "LMT, LE"
    },
    "taxonomies": [
        {
            "code": "175F00000X",
            "taxonomy_group": "",
            "desc": "Naturopath",
            "state": "KY",
            "license": "KY0196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Naturopath in Hopkinsville, KY
• Providers in Hopkinsville, KY by specialty
• Naturopath in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.