Healthcare Provider Details

I. General information

NPI: 1659638260
Provider Name (Legal Business Name): ANNE MARIE VERMILYE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 COUNTRY CLUB RD A140
EUGENE OR
97401-6003
US

IV. Provider business mailing address

4325 COMMERCE ST SUITE 111-338
EUGENE OR
97402-5467
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-3055
  • Fax: 541-225-5158
Mailing address:
  • Phone: 541-913-1397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number18582
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: