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General NPI Number Information
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NPI Number | 1841540374
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Entity Type | Organization
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Legal Business Name | VITALITY MASSAGE CLINIC
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 05/15/2014
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Provider Practice Location Address
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Address Line | 11238 SE 21ST AVE
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City | MILWAUKIE
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State | OR
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Zip | 97222-7763
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Country | US
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Telephone | 503-577-9358
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Fax |
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Provider Business Mailing Address
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Address Line | 11238 SE 21ST AVE
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City | MILWAUKIE
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State | OR
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Zip | 97222-7763
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Country | US
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Telephone | 503-577-9358
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | CASSANDRA BARTON
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Credential | L.M.T.
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Telephone | 503-577-9358
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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 | 16521
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License Number State | OR
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