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General NPI Number Information
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NPI Number | 1902628340
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Entity Type | Organization
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Legal Business Name | DEXTERITY SPA AND MASSAGE
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 880 COMMERCIAL ST SE
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City | SALEM
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State | OR
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Zip | 97302-4108
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Country | US
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Telephone | 971-236-4426
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Fax |
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Provider Business Mailing Address
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Address Line | 780 MOONFLOWER ST NE
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City | SALEM
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State | OR
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Zip | 97301-3184
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Country | US
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Telephone | 971-236-4426
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN VASHCHENKO
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Credential |
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Telephone | 971-236-4426
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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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