Indigo Earth Spa

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

License

MA63341 Issued in FL

Legal business name

INDIGO EARTH SPA

Practice address

443 Grace Ave
Panama City, FL 32401-2721

Phone

(850) 303-3669

Fax

(850) 252-6030

NPI assigned

Sep 21, 2015

Last updated

Sep 21, 2015By 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

Melissa Smith, L.M.T., F.S.

Title

Owner/Medical Massage Practitioner

Phone

(850) 303-3669

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1442793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442793600000",
    "number": "1568831485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "443 GRACE AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012721",
            "telephone_number": "850-303-3669",
            "fax_number": "850-252-6030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "443 GRACE AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324012721",
            "telephone_number": "850-303-3669",
            "fax_number": "850-252-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIGO EARTH SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-21",
        "last_updated": "2015-09-21",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "OWNER/MEDICAL MASSAGE PRACTITIONER",
        "authorized_official_telephone_number": "850-303-3669",
        "authorized_official_credential": "L.M.T., F.S."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "FL",
            "license": "MA63341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2015; 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.