Healthcare Provider Details

I. General information

NPI: 1518872852
Provider Name (Legal Business Name): NOVA VITALIS BODYWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24604 104TH AVE SE STE 204
KENT WA
98030-5385
US

IV. Provider business mailing address

24604 104TH AVE SE STE 204
KENT WA
98030-5385
US

V. Phone/Fax

Practice location:
  • Phone: 253-245-9381
  • Fax: 844-957-0077
Mailing address:
  • Phone: 253-245-9381
  • Fax: 844-957-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JEANMARIE MEIER
Title or Position: OWNER
Credential:
Phone: 253-632-6424