Provider Demographics
NPI:1578914701
Name:VERVAIR, NICHOLAS RAY (MT)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:RAY
Last Name:VERVAIR
Suffix:
Gender:M
Credentials:MT
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Mailing Address - Street 1:6610 NW WHITNEY RD
Mailing Address - Street 2:#139
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-7024
Mailing Address - Country:US
Mailing Address - Phone:360-260-6903
Mailing Address - Fax:360-260-4849
Practice Address - Street 1:3021 NE 72ND DR
Practice Address - Street 2:#15
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7300
Practice Address - Country:US
Practice Address - Phone:360-260-6903
Practice Address - Fax:360-260-4849
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMA00009214225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist