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General NPI Number Information
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NPI Number | 1215478060
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Entity Type | Organization
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Legal Business Name | UPPER VALLEY HOLISTIC HEALTH LLC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 160 PALMER CT STE. 3A
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City | WHITE RIVER JUNCTION
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State | VT
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Zip | 05001-9061
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Country | US
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Telephone | 802-649-1700
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Fax | 802-649-1704
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Provider Business Mailing Address
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Address Line | 160 PALMER CT STE. 3A
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City | WHITE RIVER JUNCTION
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State | VT
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Zip | 05001-9061
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Country | US
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Telephone | 802-649-1700
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Fax | 802-649-1704
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | RYAN CROWLEY
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Credential | L.AC.
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Telephone | 802-649-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 091.0064482
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License Number State | VT
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