Provider Demographics
NPI:1457826356
Name:VICKERY HOLISTIC MASSAGE
Entity Type:Organization
Organization Name:VICKERY HOLISTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDEY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:VICKERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:509-885-6892
Mailing Address - Street 1:6 1ST ST STE 5
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2247
Mailing Address - Country:US
Mailing Address - Phone:509-885-6892
Mailing Address - Fax:
Practice Address - Street 1:6 1ST ST STE 5
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2247
Practice Address - Country:US
Practice Address - Phone:509-885-6892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-06
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty