Provider Demographics
NPI:1699390526
Name:VIVERE MASSAGE THERAPY LLC
Entity Type:Organization
Organization Name:VIVERE MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAGAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:360-461-1239
Mailing Address - Street 1:206 MOTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-2540
Mailing Address - Country:US
Mailing Address - Phone:360-461-1239
Mailing Address - Fax:
Practice Address - Street 1:206 MOTOR AVE
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-2540
Practice Address - Country:US
Practice Address - Phone:360-461-1239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty