MEDICARE: MS. VIVIAN FAYE CHARVAT LMBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	18327	NC

General Provider Information

NPI Number	:	1598589384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIVIAN FAYE CHARVAT LMBT

Provider Business Mailing Address
First Line	:	1506 SHELBY HWY LOT 3
Second Line	:
City	:	BLACKSBURG
State	:	SC
Zip	:	29702-9681
Country	:	US
Telephone Number	:	619-323-8850
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 N LAFAYETTE ST
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4445
Country	:	US
Telephone Number	:	704-692-0417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2024
Last Update Date	:	11/08/2024

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