Healthcare Provider Details

I. General information

NPI: 1386241669
Provider Name (Legal Business Name): VIBRANT THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 KINGS CANYON CT
HENDERSON NV
89012-5811
US

IV. Provider business mailing address

201 KINGS CANYON CT
HENDERSON NV
89012-5811
US

V. Phone/Fax

Practice location:
  • Phone: 229-561-5678
  • Fax:
Mailing address:
  • Phone: 229-561-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESSICA GARRETT
Title or Position: OWNER
Credential:
Phone: 229-561-5678