Spa Land Mobile Spa

Primary specialty

Massage TherapistTaxonomy code 225700000X

Legal business name

SPA LAND MOBILE SPA

Practice address

12636 W Outer Dr
Detroit, MI 48223-3202

Phone

(833) 221-4169

NPI assigned

Dec 18, 2024

Last updated

Dec 30, 2024By 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

Brandy Ali

Title

Presdient

Phone

(833) 221-4169

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1734480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735516800000",
    "number": "1770390148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12636 W OUTER DR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482233202",
            "telephone_number": "833-221-4169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12636 W OUTER DR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482233202",
            "telephone_number": "833-221-4169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPA LAND MOBILE SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-18",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "PRESDIENT",
        "authorized_official_telephone_number": "833-221-4169"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; 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.