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General NPI Number Information
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NPI Number | 1275221632
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Entity Type | Organization
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Legal Business Name | BODY VITALITY LLC
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 14511 NE 10TH AVE STE F
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City | VANCOUVER
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State | WA
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Zip | 98685-1386
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Country | US
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Telephone | 360-214-2763
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Fax | 360-925-3988
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Provider Business Mailing Address
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Address Line | 14511 NE 10TH AVE STE F
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City | VANCOUVER
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State | WA
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Zip | 98685-1386
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Country | US
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Telephone | 360-214-2763
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Fax | 360-925-3988
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Authorized Official
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Title or Position | OWNER, MASSAGE THERAPIST
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Name | NICOLE SNYDER
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Credential | LMT
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Telephone | 360-214-2763
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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 |
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License Number State |
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