Healthcare Provider Details

I. General information

NPI: 1861017808
Provider Name (Legal Business Name): NALANI'S LMT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5773 FAR HILLS AVE
CENTERVILLE OH
45429-2207
US

IV. Provider business mailing address

5349 DUSHORE DR
DAYTON OH
45417-8831
US

V. Phone/Fax

Practice location:
  • Phone: 937-727-3111
  • Fax:
Mailing address:
  • Phone: 937-727-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE MARIE JACKSON VICENTE
Title or Position: OWNER
Credential: LMT
Phone: 937-623-0689