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General NPI Number Information
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NPI Number | 1326861048
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Entity Type | Organization
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Legal Business Name | VITALITY MASSAGE & BODYWORK
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 200 E 2ND ST STE 103
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City | NEWBERG
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State | OR
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Zip | 97132-3083
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Country | US
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Telephone | 503-460-7356
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Fax |
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Provider Business Mailing Address
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Address Line | 26160 SW CANYON CREEK RD APT 303
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City | WILSONVILLE
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State | OR
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Zip | 97070-8661
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Country | US
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Telephone | 503-460-7356
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRANDON MARTIN
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Credential | LMT
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Telephone | 503-460-7356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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