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General NPI Number Information
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NPI Number | 1740672161
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Entity Type | Organization
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Legal Business Name | NOUVELLE VIE THERAPY, CORP.
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Dates
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Enumeration Date | 02/22/2015
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Last Update Date | 02/22/2015
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Provider Practice Location Address
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Address Line | 916 NW 167TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1478
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Country | US
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Telephone | 217-371-6369
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Fax |
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Provider Business Mailing Address
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Address Line | 916 NW 167TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1478
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Country | US
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Telephone | 217-371-6369
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANNETH CLAVIJO
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Credential | MASSAGE THERAPIST
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Telephone | 786-227-2494
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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 | MA235512
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | MA235512
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License Number State | FL
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