Provider Demographics
NPI:1558736314
Name:LA VITA BELLA THERAPEUTIC MASSAGE & BODYWORK
Entity Type:Organization
Organization Name:LA VITA BELLA THERAPEUTIC MASSAGE & BODYWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-396-9617
Mailing Address - Street 1:59113 OAK GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-2866
Mailing Address - Country:US
Mailing Address - Phone:503-396-9617
Mailing Address - Fax:
Practice Address - Street 1:51577 COLUMBIA RIVER HWY STE D
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-8409
Practice Address - Country:US
Practice Address - Phone:503-396-9617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14160261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center