MEDICARE: VIBRANT LIFE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1043634140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIBRANT LIFE LLC

Provider Business Mailing Address
First Line	:	1321 20TH ST
Second Line	:	SUITE A
City	:	SACRAMENTO
State	:	CA
Zip	:	95811-4233
Country	:	US
Telephone Number	:	916-346-1839
Fax Number	:	916-414-3669

Provider Business Practice Location Address
First Line	:	1321 20TH ST
Second Line	:	SUITE A
City	:	SACRAMENTO
State	:	CA
Zip	:	95811-4233
Country	:	US
Telephone Number	:	916-346-1839
Fax Number	:	916-414-3669

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CHRISTINA MUTH
Credential	:
Telephone Number	:	916-346-1839

Provider Enumeration Date	:	02/10/2014
Last Update Date	:	07/21/2014

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Directions to “VIBRANT LIFE LLC ” Practice Location

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