Provider Demographics
NPI:1275221632
Name:BODY VITALITY LLC
Entity Type:Organization
Organization Name:BODY VITALITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:360-214-2763
Mailing Address - Street 1:14511 NE 10TH AVE STE F
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-1386
Mailing Address - Country:US
Mailing Address - Phone:360-214-2763
Mailing Address - Fax:360-925-3988
Practice Address - Street 1:14511 NE 10TH AVE STE F
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-1386
Practice Address - Country:US
Practice Address - Phone:360-214-2763
Practice Address - Fax:360-925-3988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center