Healthcare Provider Details

I. General information

NPI: 1043727951
Provider Name (Legal Business Name): VANESSA MOYERS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA AUSSERESSES LMT

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 NE HIGHWAY 99W
MCMINNVILLE OR
97128-2723
US

IV. Provider business mailing address

1316 NE HIGHWAY 99W
MCMINNVILLE OR
97128-2723
US

V. Phone/Fax

Practice location:
  • Phone: 503-434-6603
  • Fax: 503-434-6746
Mailing address:
  • Phone: 503-434-6603
  • Fax: 503-434-6746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23890
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: