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General NPI Number Information
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NPI Number | 1962778977
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Entity Type | Organization
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Legal Business Name | V H DIRECT WELLNESS INC.
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Dates
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Enumeration Date | 03/25/2012
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Last Update Date | 03/25/2012
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Provider Practice Location Address
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Address Line | 9974 BOCA GARDENS TRL APT D
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City | BOCA RATON
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State | FL
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Zip | 33496-3729
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Country | US
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Telephone | 561-929-4316
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Fax |
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Provider Business Mailing Address
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Address Line | 9974 BOCA GARDENS TRL APT D
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City | BOCA RATON
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State | FL
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Zip | 33496-3729
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Country | US
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Telephone | 561-929-4316
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | SANDRA J VAN HORN
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Credential | LMT
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Telephone | 561-929-4316
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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 | MA53938
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License Number State | FL
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