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General NPI Number Information
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NPI Number | 1902970296
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Entity Type | Individual
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Provider Name | GARY H VIGEANT LMP
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 09/09/2007
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Provider Practice Location Address
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Address Line | 316 E FOURTH PLAIN BLVD SUITE B
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City | VANCOUVER
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State | WA
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Zip | 98663-3074
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Country | US
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Telephone | 360-993-0599
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Fax | 360-993-0599
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Provider Business Mailing Address
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Address Line | 815 E 29TH ST
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City | VANCOUVER
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State | WA
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Zip | 98663-2713
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Country | US
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Telephone | 360-695-0378
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MA 00020866
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00022138
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 11901
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License Number State | OR
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